International Cesarean Awareness Network

1.       This is a stunningly awful PR move on the part of insurance
companies.  Denying c/s moms insurance unless they’ve been surgically
sterilized?   These policies punish women indiscriminately.  Though
the NYT article indicates that companies are denying coverage to women
who had an "elective" cesarean, ICAN women know full well that many of
the "elective" cesareans noted in medical charts are performed against
the wishes of mothers and only because the doctor predicted dire harm
with a vaginal birth.  Raise your hands – how many of you got the
"your baby is sooooo big, it will get stuck and die" speech?  How
about the "you’ve gone overdue and your baby will probably die if we
don’t induce/section you?"  Let’s not forget the "you’re low on
amniotic fluid and your baby has nothing to breathe" speech.  Too many
women in the U.S.  end up with cesareans for very suspect reasons.
These cesareans aren’t elective or medically necessary…they are
bullied.

2.       As much as I would love to pillory the insurance companies, I
don’t think they’re the core of the problem.  They are the symptom of
a larger issue. Insurance companies are nothing but a combination of
meticulous  bean counters and professional gamblers.  They  gather
giant amounts of data on their beneficiaries – the health services
they use and how much it costs them –  and use that data to make good
guesses about who is their best financial bet to cover.  But with the
obstetric community fueling a rapid increase in use (and overuse) of
cesarean for the sake of their own convenience or protecting
themselves from liability risk, health insurance companies have
essentially been financing a lifestyle improvement for OBs.  Now
they’re saying "enough."  But instead of creating consequences for the
OBs who have been shamelessly overusing this surgery without any
benefit to mothers or babies, they are punishing moms.  Please refer
back to observation #1.  Dumb, dumb, dumb.

3.       These policies are a validation to what ICAN and other
maternity care organizations have been screaming into the
wind…cesareans come at a cost.  They are not "fashionable" nor are
they a "tidy" way to give birth.    They should only be done when
there is a clear and definable benefit to mother or baby because they
carry short term and downstream risks of complications for mothers and
babies.   Those complications cost money.  The insurance companies
know this because they’re stuck with the bill.  So the next time an OB
(even if they are part of an NIH committee) stands up and says that
cesareans are no big deal and gee, we don’t have enough evidence to
know one way or another, get your rotten tomatoes ready.  It’s bogus.
Time for moms to get the message and vote with their feet.  (If you’re
pregnant, have you interviewed your local midwife yet??)

4.       Kudos to Denise Grady of the NYT for covering this story.
Since it’s an early trend, this could have flown under the radar for a
long time.  And though many reporters in the last 2 years have jumped
on the "Blame Moms Express" by reporting on the elective cesarean
"trend" as the cause of the rising rate, Ms. Grady accurately reported
that there is no data to substantiate that mothers are asking for
cesarean in substantive numbers.  Childbirth Connection has the best
data out there on this in their Listening to Mothers survey.  Here’s a
great explanation of the rate of "elective" cesarean section.
http://www.childbirthconnection.org/article.asp?ClickedLink=742&ck=10375&area=27
Go read it.  You’ll be smarter for it.   Ms. Grady also did a great
job of "connecting the dots" and pointing out the maddening illogic of
hospitals forcing women to have cesareans against their wishes through
VBAC bans and then insurance companies punishing them by denying them
coverage.  I wish we’d seen her demand more accountability from ACOG
though about the runaway c/s rate, since we wouldn’t even be having
this conversation if it weren’t for their gross overuse of surgery.
In the article, Dr. D’Alton suggests the medical profession needs to
take a "stand" on this.  How about some meaningful measures to drive
down the c/s rate for one?

5.       This trend could be a sign of things to come.  I’m guessing
that insurance companies may be testing the waters and moving towards
policies of denying coverage for "elective" cesareans.  If they do
that, I will stand behind them in support.  I’m not interested in
paying for unnecessary cesareans any more than I’m interested in
paying for other people’s nose jobs or tummy tucks.  But the real
question is whether insurance companies will be able to tell the
difference between an "elective" cesarean and one that a woman has
been bullied into.  Is there a billing code for "My doctor told me my
baby would die if I didn’t agree to a stat c/s, but it turns out that
she just had tickets to the opera"?