Alex Nussbaum has an article up at Bloomberg.com called Aetna Urges Moms To Avoid Cesareans Births To Reduce Risk. The title appears to be inaccurate, as Aetna has actually renegotiated maternity payments with 10 hospitals in the country and “moms” don’t appear to be involved in any of it.
Here is the excerpt in which Nussbaum covered my interview with him. We talked for at least 45 minutes, but he distilled it down due to space constraints to something that really went straight to the heart of why the blog came into existence.
The U.S. isn’t alone in bending Mother Nature to modern medicine. Cesarean levels have reached “epidemic proportions” in many countries, the World Health Organization said in a report two years ago. The U.S. rate is on par with some Latin American nations and Australia but well ahead of the U.K., France and Norway, all with cesarean rates at 22 percent or less, the WHO said.
The backlash against the procedures has spawned its own website, The Unnecesarean, where San Diego mom Jill Arnold shares tales of women who felt pushed into C-sections.
Arnold, 38, was persuaded by doctors to schedule a cesarean in 2005 after being told her baby might be too large, she said. She went into labor before the operation and delivered her daughter, Maggie, normally and without incident.
Two years later, she gave birth to a second girl, Molly, at an independent birth-center where she felt “more in control.” She started the website after hearing from other mothers who felt pressured while finding more research that questioned the approach.
“They feel either lied to or deceived or that they were pushed really heavily in one direction and later found out the medical indication wasn’t there,” Arnold said. “They feel they were railroaded.”
Nussbaum asked me in the interview about insurance companies getting involved in trying to limit cesarean births. Besides the probable conflict of interest in trying to save money, there are most likely public health benefits. On top of that, it could pave the way, in theory, for a patient to be faced less of a brick wall when looking to give birth vaginally in a hospital. Not only would this have possible positive public health implications, but could lead to greater patient satisfaction because patients will be more likely to find care that is consistent with their values and preferences.
In the interview with Nussbaum, I shared what I think is a foreseeable problem that can be circumvented this time around. When VBAC became the standard of care in the 90’s, many women were told the complete opposite of what women in the U.S. are told today—sorry, we don’t do repeat cesareans. In my opinion, any proposed economic incentives should never prevent patients from seeking preference-sensitive care.
There is a lot to discuss here. Obviously, as Elliott Main addresses in the article, there are perverse incentives for expedience on the doctor’s part:
C- sections not only pay more; along with inductions they also allow doctors to cluster births and schedule other visits around them, he said. And they assure a physician will be on hand for a delivery — and get the insurance payment — when a baby arrives.
The gap to focus on here is that between hospital reimbursement and physician reimbursement. According to the article, hospitals are reimbursed twice as much for cesareans as they are for vaginal deliveries. Not in the article, however, is that physician reimbursement is about the same for vaginal and cesarean deliveries— $3390 versus $4086 on average in 2011.