Raising Women’s Voices

The Medical and Insurance Risks of C-Sections

Posted in Maternity Care, Reproductive Health Care by raisingwomensvoices on February 26, 2009

These days, it is easier for a woman to undergo a major abdominal surgery–a C-Section–than to deliver a baby vaginally. C-Sections are now the most common surgeries performed on women in the United States. In part that is because many doctors and hospitals refuse to perform vaginal birth after cesarean (VBAC). More than 90% of births following C-sections are surgical deliveries, and the International Cesarean Awareness Network (ICAN) has found that, of 2,850 hospitals called, 28% don’t allow VBAC, up from 10% in 2004. Another 21% do not have an official policy on VBAC, but do not have any doctors that will perform them, rendering them inaccessible, as well.

vbac

If VBACs cost less and allow the mother to heal quicker, why is this the case? Yes, there is a real threat of uterine rupture, which can cause maternal or infant fatality, but this occurs in 0.7% of VBAC cases. 1 in 2,000 babies will die or suffer brain injury.

In 1999, the American College of Obstetricians and Gynecologists changed their VBAC guidelines stipulating that surgeons and anesthesiologists should be “readily available” during a VBAC to “immediately available,” due to a number of high-profile uterine ruptures. Because of malpractice suits, insurers have raised costs so they are unaffordable for some doctors. Other doctors see a potential 24-hour delivery as a loss of other patients, and prefer an hour-long Cesarean.

But this does not come without both health and insurance risks to women. Risks associated with repeat C-Section are routinely overlooked, but they are real. Placenta accreta, where the placenta attaches abnormally to the uterine wall, has increased thirtyfold in the past 30 years.

And women who have had C-sections, whether they have elected to do so, have been pressured by doctors, or have had emergency C-sections due to fetal distress, now find themselves uninsurable in some cases, or subject to higher premiums in others, a C-Section now acting as a pre-existing condition.

Peggy Robertson, who has had a C-section, was denied coverage from Golden Rule Insurance Company, and was told if she had been sterilized after the procedure, or if she were over 40 and had given birth two or more years before applying, she might have qualified for coverage. Golden Rule also explained that if they could cover her with the exclusion of paying for another Cesarean in three years, they would, but in Colorado that is considered discriminatory. Somehow, not covering a woman who has had a Cesarean, is not.

The number of women looking for insurance outside group plans and the number of women having C-sections is only increasing, meaning more women will find themselves in Ms. Roberton’s position. “Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of ICAN, by pushing for C-sections, whether the first time, or in lieu of VBACs. Women now find themselves having surgery they might not want, and with insurance companies that will not cover the cost.

Perhaps most disturbing about this C-Section epidemic is that women can be red-flagged if they answer “yes” to having been denied coverage before, even if they applied without knowledge of the C-Section stipulation. And medically, many women are steered towards doctors’ preferences, rather than being provided with accurate medical information. Childbirth Connection, an NYC based maternal-care advocacy group, has found that 57% of women who had had C-Sections and gave birth again  in 2005 were interested in a VBAC but were denied the option of having one.

For more, click for the Time article here and the New York Times article here

sara siegel

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