:: to the teeth ::   thoughts on social justice, medicine, race, hope and beats
"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::
"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Sunday, January 29, 2006
Pregnant and Uninsured:
i had a follow-up visit from a pregnant patient. she had seen me two months ago for initial medical care while awaiting Medicaid approval. turns out her husband, who works three jobs, makes a little bit too much for Medicaid so they didn't qualify. of course with three jobs, he's uninsured since none are full time.
i put this out on the blog to make a clear point that one of the most basic and beautiful human functions - pregnancy and birth - can turn into a financial nightmare for parents. i know some people who call themselves conservative (what exactly are they conserving?) might say "so what." " if people cannot afford to have a baby, they shouldn't have a baby."
i'd like to point out an uncomfortable truth. it is not expensive to be pregnant, or to have a baby. it's actually free, unless you happen to crave really expensive food, something like caviar braised lobster in a bed of godiva chocolate.
what is expensive about pregnancy and birth is the systems put in place to "manage" and "care for" pregnant women. a hospital birth has a price tag around $2000-4000, if it's normal. $5-10,000 if it's a C-Section. Prenatal care, including labs, can cost around $500-2000 as well. high risk pregnancies can be alot more expensive, up to $30,000 or more.
now consider receiving your care from a midwife. midwives are a diverse group, some emphasize labs and technology more than others so there will be a wide range of costs. i've seen charges, including necessary labs and a few home visits for the newborn baby, ranging from $800-$1500 and up.
in New Mexico, there is a vibrant and healthy midwife community. birthing centers exist and more are opening. midwives are organized politically to help shape Medicaid policy. yet many patients choose expensive hospital births instead of midwives and the overwhelming reason is FEAR. groundless fears.
For example, this patient was told she has a high risk pregnancy because she experienced 2 months of hyperemesis gravidarum (severe morning sickness). she needed IV fluids a few times and some anti-nausea medications. the "high risk" statement was probably a random comment from the doctor, but it escalated her fear over the pregnancy. the truth is that women who have morning sickness usually have stronger pregnancies. the nausea is caused by higher levels of hormones put out by the placenta, which is doing it's job vigorously. of course the vomiting can cause dehydration and pregnancy complications but the solution is very simple. access to affordable health care with IV fluids and nausea medications. this is not a "high risk" pregnancy.
a preaching moment: as doctors, we need to stop perpetuating the myth that pregnancy is an illness, that it is dangerous, that hospital birth is safer than home birth. we need to learn how to differentiate high risk from low risk women and counsel women and families appropriately. and at the least, support women and families that want a more natural approach to a very natural biological "process" - BIRTH.
posted by andru | 1/29/2006 10:37:00 AM | |
I completly agree with everything you are writing, as a social worker and a doula (birth coach) I often find myself up against a culture of people who believe anyone who doesn't give birth in a hospital is putting their child and self in danger. I try to be tolerant and teach people but it is very frustrating to explain all of the reasons why giving birth in a hospital not only costs more, but increases your chances of interventions and c-sections. Not only that: something I am particularly interested in is Posttraumatic Stress Disorder related to Childbirth. Women often don't realize they will be left alone for long periods of time and they become fearful. This fear can make pain much more unbearable, and the entire experience can be traumatic. If you are a person who wants to see the statistics and data, the best book I have found is The Thinking Woman's Guide to a Better Birth by Henci Goer.
# posted by : 1/29/2006 7:01 PM
i both agree and disagree. i don't think pregnancy is an illness. that being said, i know for a fact that home births can go terribly, dreadfully wrong, even in pregnancies that were completely "uncomplicated" and low-risk. i don't think you can ever have that warm, fuzzy picture in your head of a home birth once you've seen a full-term baby die due to severe hypoxic ischemic encephalopathy. even worse, see the ones with HIE who survive and are essentially just brainstems, dependent on their grief-stricken parents as much as their g-tubes and trachs. i mean, let's be honest. there's a reason that maternal and child mortality declined so precipitously since the inception of the germ-theory of disease and hospital births.
i appreciate your recommendations. there are private hospitals creating birthing centers.
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