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Thursday
Jul162009

Obama Says Women Must Have a Natural Childbirth to Save Money?

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Dick Morris, author of Catastrophe, stated on the June 24 edition of The O’Reilly Factor that “right now the government is telling people, cut back on cesarean sections, go through natural childbirth. It’s a lower cost.” 

 

Media Matters, a Web-based, not-for-profit, research and information center whose mission is to comprehensively monitor, analyze, and correct conservative misinformation in the U.S. media, posted a video of the O’Reilly-Morris interview and reported the following on its site on June 25, 2009:

In fact, the Obama administration has not advocated “cut[ting] back on cesarean sections.” Rather, the American Medical Association (AMA) proposed addressing “the overuse of certain services or procedures,” [emphasis added] including cesarean sections, in response to the administration’s stated goal of reducing the growth in health care spending.

The AMA and five other health care organizations issued the proposals in a June 1 letter to Obama to address the overuse of certain procedures. In its attachment to the letter, the AMA stated that the “AMA-convened” Physician Consortium for Performance Improvement (PCPI) recommended addressing “the overuse of certain services or procedures,” including “Induction of labor/Caesarean Sections.”

 

Read an excerpt from the AMA attachment, Efforts to Reduce Unnecessary Utilization, as well as a transcript of the interview on The O’Reilly Factor here.

 

The Morris “natural childbirth” interview preceded this week’s international media and blog furor over midwife Denis Walsh’s not-yet-published article,“Epidural Culture,” which was submitted to the journal Evidence Based Midwifery and is currently under peer review according to the Royal College of Midwives.

According to the BBC, Walsh claims that pain in labor is known to have positive physiological effects and triggers the release of endorphins to aid women in adjusting to the pain. Additionally, he calls pain in labor a rite of passage that help a woman adjust to the responsibilities of mothering. Walsh allegedly writes that epidurals have known risks, such as an increased need for synthetic hormones to augment labor and increased rates of instrumental deliveries. The BBC quotes Walsh expressing concern that the long-term effects of increasing epidural rates are unknown.

 

As of yet, there have been no media reports that “natural childbirth” will be required of women by the U.S. government to control health care cost, nor will cesareans be systematically denied to those in need. Furthermore, it appears that epidural anesthesia will remain available in U.K. hospitals in spite of the content of a not-yet-published article by one midwife.

 

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Reader Comments (12)

I just saw on Twitter that Louise Marie Roth wrote about Dick Morris and his silly cesarean comment and more on Huffington Post on June 29. It's very thorough and, as usually happens on HuffPo to maternity care related stories, it got fewer comments than it deserved.

July 16, 2009 | Registered CommenterJill

I'm not sure what to think about this. I don't agree with the medical side of the maternity care in our culture, and I wish that natural birth was explained and used more than it is. It has DEFINITE positives that medicated birth doesn't have.

And even though cutting down on cesareans would lower state and government costs by millions every year, I have never actually heard of anyone saying that natural birth is better because it is cheaper. If our government truly started pushing this, the ACOG would push right back, because they get the most money from medicated births and cesareans.

I wish that we had someone in the government that was helping employ natural birth practices, but I don't ever see it happening.

July 16, 2009 | Unregistered CommenterKayce

You know, not that I agree with any of the main players in this piece, but the cost of cesarean is not a completely taboo subject. I am developing a research project on maternity care that will look at cesarean as an outcome, and one of my goals is to do a cost analysis. If it costs more AND has worse health outcomes, it is obviously a wrong wrong wrong treatment choice. However, I have never heard of anyone suggesting simply lowering the cesarean rate. I think everyone's goal is to lower the unecessary cesarean rate. And, no one's goal is to simply slash costs. The goal is to slash unecessary costs.

Threatening a slippery slope right here is a little ridiculous, since we are careening in the opposite direction.

July 16, 2009 | Unregistered CommenterMomTFH

"As of yet, there have been no media reports that “natural childbirth” will be required of women by the U.S. government to control health care cost, nor will cesareans be systematically denied to those in need."

I vaguely remember reading an article a year ago or so. I don't remember who wrote it or where, but it was a first-hand account of an American citizen birthing in a European (Dutch?) hospital. In the telling of her story, she described how the use of epidurals in their birthing culture was looked down upon, and that epidural anesthesia was NOT routinely available (i.e. it took considerable planning and effort to have one in place should one choose to use it.) She implied that it was somehow repressive and unfair to deny a woman her "right" to epidurals, and her tone in general was rather critical of the culture for trying to "force" their belief system on all comers, IIRC.

(Gosh, I wish I could remember this better, ring any bells for anyone?)

I find it terribly interesting that modern women, esp. American women, tend to define such things as choices in a framework of belief system, instead of biological imperatives that one may or may not choose to heed (with resultant consequences.) The same is true for breastfeeding, circumcision, natural birth, etc etc. Granted, one's belief system may affect whether one chooses to heed that biological imperative, and far it be for us to say whether or not their choice is valid, but it cannot be be argued that the biological imperative IS the preferred state, and that we would do well to present that as the default option, with all other choices being considered frivolous and/or potentially harmful.

I still have a hard time understanding how stating the consequences for certain choices equals condemning that choice. Or for that matter, why trying to limit potentially harmful and costly choices equals loss of choice. Just because the option becomes less accessible, or loses official sanction, does not remove the choice. Unless what women want isn't choice, but validation?

July 16, 2009 | Unregistered CommenterEmily Jones

Personally I think natural is better, but I've yet to experience it firsthand. Of the women whose stories I've read, quite a few who've experienced both prefer natural. Telling women that they have to go natural to save the system money, instead of presenting natural, unfettered, undrugged, untimed birth as a valid and attainable choice with positive health benefits for both mother and baby, will undoubtedly cause a backlash from women themselves. Instead of fighting for the option for physiological birth in institutions and at home, women will be fighting to preserve the medical model. What a reverse psychology mind-f&*k.

July 16, 2009 | Unregistered CommenterAnon

MomTFH, I don't think cost of cesareans is a taboo subject, either. I'm curious about all of the variables you'll look at in your cost analysis. Sounds interesting.

July 16, 2009 | Registered CommenterJill

Kayce, I think by saying "natural birth," Dick Morris meant "vaginal birth." The accusation was that Democrats will cause necessary procedures, like cesareans, to be denied. As a result, women will have to have a vaginal birth even if they need a cesarean.

He pulled it out of his butt.

July 16, 2009 | Registered CommenterJill

Emily, I don't remember the story to which you're referring but I do remember at the beginning of the year (?) when the NHS in the UK proposed charging for unnecessary epidurals to save costs and people were furious.

July 16, 2009 | Registered CommenterJill

Emily said: "it cannot be be argued that the biological imperative IS the preferred state"

Sure it can. Unless you add on "from a health perspective" or "from an epidemiological standpoint," and I think even those could be challenged. I think I know what you're saying, though. "Choice!" gets sort of glorified in rhetoric. It's always interesting (in general) to watch people discuss personal freedom and choice between two crappy options and ignore the big picture, in which there may be five other options. That's not necessarily related to women's health; rather, just something I've noticed in online semi-intellectual ping pong matches.

July 16, 2009 | Registered CommenterJill

Anon, that proves it. Denis Walsh is a double agent for RCOG.

Kidding, of course. I hadn't considered that threatening to ban epidurals or limit their availability (hypothetically) could create a free army of people advocating for a fully medicalized childbirth and all that goes along with it. While arguing for their right to epidural anesthesia in labor, they are simultaneously arguing for everything else that goes along with having to support a patient hooked up to an epidural. That's pretty interesting.

July 16, 2009 | Registered CommenterJill
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