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Utah Lawmaker May Propose Cutting Use of Epidurals to Save Money

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By Jill—Unnecesarean



From the Daily Herald:

Under the theory that perhaps thousands of Utah college students are having babies paid for by Medicaid that they could pay for themselves, one lawmaker has a plan: cut all elective epidurals and elective C-sections.

Sen. Dan Liljenquist, R-Bountiful, has vowed massive Medicaid reform in next year’s legislative session, and first on the list is people who may be freeloading. Medicaid pays for 15,000 births a year in Utah, a third of the total, Liljenquist says.

“Do we save some kid or make birth easier?” he said, noting that the waiting list for Medicaid in Utah just for the disabled has reached 4,400 people.

Liljenquist says the state could save millions. Epidurals, a shot given in the spine, are a common method of relieving pain during labor. At Utah Valley Regional Medical Center in Provo, 86 to 87 percent of women who deliver babies at the hospital get an epidural; studies show about 65 percent of births nationwide happen with an epidural.


Denying patients epidural anesthesia is a great way to put misogynistic, classist douchebaggery into action. Rich women will be able to afford paying for pain relief and poor and middle class women will not have access to it. It’s about as thoughtful a move as trying to force more women to breastfeed by making formula available by prescription only.

Dick Morris tried to scare the public last year into believing that the Obama administration had plans to force women to go through “natural childbirth”, telling Bill O’Reilly 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.” It never happened and neither will this.

Utah already has the nation’s lowest cesarean rate at 22.2 percent



Hat tip: Woman to Woman’s new Facebook page.

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Reader Comments (58)

I always appreciate a good application of the word 'douchebaggery.' It is hard for me to imagine something like this passing, as much as we like to screw the poor and young. After all, childbirth is the WORST THING IN THE WORLD and we must be compassionate and save women from it with technology. As an aside, is the 65% epi rate accurate? I always thought it was in the 90s.

August 19, 2010 | Unregistered CommenterAnother Rachel

Playing devil's advocate here, I do have to say, there's a difference between what people have a right to have if they themselves are paying for it, and what they have a right to have paid for by other people. After all, you could take this one step further and say that everyone has a right to free postpartum help during their 12 weeks of recovery from the c-section that they got for free, which they needed because of the free epidural they got which was another step in the cascade of free interventions they received during their free hospital stay.

If a state's budget only allows for so many services, they have to prioritize. And I'm sorry, but an epidural is not as necessary as some of the other services that medicaid recipients might require instead. And who says that just because someone is poor, they're entitled to receive everything under the sun?

My husband lost his job last week. Our third child is due in a couple weeks. When this baby is born, we will have no health insurance. Even if he finds a new job this week, our new insurance wouldn't kick in until the beginning of the next month, after the birth. And yet we couldn't get government assistance if we wanted or needed it, because our income last year and the first part of this year disqualifies us. Mind you, we will be birthing at home and won't need hospital maternity services, but what if we did? We'd be paying out of pocket for my epidural and IV and c-section. Why should someone else get these things for free just because they want (not need) them? This is the first time my husband has been unemployed in his 17-year career; we have always worked hard for what we have. And yet in the case of our upcoming birth, it would have been better for us to not go to college, not work hard, and not have to think about where everything we want in life would be coming from. Then at least I might have health insurance for this birth, right?

I'm not for denying people the things they need. It's just that, as a (recent) taxpayer, I don't think I should have to pay for things people just WANT. Like epidurals.

August 19, 2010 | Unregistered CommenterKaren

I think maybe they should concentrate on the root of the problem here: Inductions. Pitocin makes labor just about unbearable and often is the first of many interventions that lead to an otherwise unnecessary c-section. Stop inducing women before the baby is ready (unless, I suppose, they reach that magical 42 week mark) and you'll have fewer interventions, including epidurals and c-sections.

August 19, 2010 | Unregistered CommenterLaura G

I just edited this (1:54pm) to include the link to the article. Someone mentioned on the Facebook page that she read the article and linked to it. I wondered what the deal was since it was already linked... but I never linked it. Sorry.

Interesting discussion on FB.

August 19, 2010 | Registered CommenterJill

Karen, I hear what you're saying. I question anything that gets into a situation where women can't freely chose what to do with their bodies. Obviously there are exceptions to every sweeping statement like that, but I don't like anything that gets into forced birth territory.

The use of the word "elective" in this article is intended to mean desired but not medically necessary (as opposed to the term "elective cesarean", which has come to mean a non-emergency c/s). The full article shows that there's punitive reasoning behind the wanting to cut these specifically, as he sees these women as freeloaders.

I used to question why some insurers covered maternal request (not elective) cesareans. Courtroom Mama pointed out in the comments here that it had potential to getting into a situation in which women were being forced to give birth vaginally against their will. On top of that, it perpetuates a system in which the rich have access to choices that the poor do not.

August 19, 2010 | Registered CommenterJill

This is the problem with any government-sponsored health insurance. What is considered "necessary" care, and what is considered "elective" care?? These are difficult questions, and once the population has ceased to consider healthcare a service that they purchase, and begin to view it collectively as a right they deserve, this gets increasingly difficult. Epidurals are far from the only medical service that will come under scrutiny. If a person's quality of life is improved by an elective procedure, is it necessary? Do we make these decisions on a case-by-case basis, or on a broader level? People focus on the hot-button items - care for the elderly, abortion, birth control, prenatal and birth services, but these issues will cross into all medical disciplines. Could it be argued that those breast implants are necessary because the patient is severely depressed about her small boobs (the implants may be cheaper than therapy)? Or could we argue that because that last-ditch treatment only has a 5% success rate we won't cover it because the cost-benefit ratio is too low (if you had a 5% shot at seeing your kids grow up, would you want the right to decide to try it?)?? It's naive to think that medical services will only be provided as deemed necessary by medical professionals in consultation with their patients - this will be at least in part a political and economic decision.

August 19, 2010 | Unregistered CommenterIsabel

@Karen: How do you determine whether a woman's request for an epidural is a "want" or a "need"? It seems to me that if a woman is requesting an epidural, it is because she feels she needs it -- whether that need is based in actual pain, perceived pain, a need to rest, emotional or physical issues that are affected by or reactive to the birth process, or something else entirely. Good luck with your upcoming birth! I hope you have the peaceful homebirth you have planned.

August 19, 2010 | Unregistered CommenterDana

I live in Utah, and this cuts to the core. We have a high birth rate here, as well as a high epidural rate. I know a LOT of women who will kick and scream if they're denied an epidural because of funding concerns. I doubt this will pass, but even the notion is upsetting. Personally I don't choose an epidural or elective cesarean, and I support unmedicated birth as well as home birth. I actually had Medicaid with my last pregnancy but chose to pay out of pocket for a home birth instead. However, I also support each woman's right to choose, and taking an option away that over 80% of women choose is utterly ridiculous.

August 19, 2010 | Unregistered CommenterCherylyn

I guess I understand the throught process. But still, major FAIL. Pain relief is not considered "elective" in any other branch of healthcare, nor should it be.

August 19, 2010 | Unregistered CommenterAugusta

Pain relief only considered "elective" when needed by women, doing something only women do! Thanks, misogynistic, classist douchebaggery! (Definite win on that phrase.)

The FB discussion is pretty interesting! It made me realize that I simultaneously believe the following:
1) Epidurals are a useful tool in labor and I have seen them used very effectively
2) Epidurals can be the beginning of, or an intermediate step in, the cascade of interventions
3) A woman has the right to an elective epidural if her hospital offers them, and to deny them to women who cannot pay is a violation of her rights
4) A perhaps surprising number of hospitals do not offer them because they do not have in-house anesthesia, and (as long as they offer other modes of pain relief) that is not a violation of the rights of their patients
5) Many women who are induced will need an epidural for pain relief, and I would venture to say that inducing without an epidural available infringes on a violation of the rights of the patient (and yes I have seen this done and it was awful)


August 19, 2010 | Unregistered CommenterRebecca
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