Wasting Health Care Dollars

My best friend is an emergency room nurse at a large hospital in Denver, Colorado.  In the past two months, two of her friends have given birth.  One is a fellow nurse, and the other a dentist.  Both have a solid knowledge base in medicine, and had thoroughly researched pregnancy and childbirth.  Both women wrote birth plans and shared them with their doctors.  In both cases, the doctors agreed to the birth plans, which included strong desires for childbirth that would be as natural as possible, with minimal intervention unless medically necessary.  No epidurals, no episiotomies, no unnecessary monitoring. 

When the nurse was in the midst of labor, she noticed a doctor approaching her with a needle.  She asked him what he was doing, and he told her he was prepping her for an episiotomy.  She reminded him that they had discussed this very procedure, and that she had specifically said she did not want one.  He then told her that the hospital does them ‘routinely.’  At her insistence, he backed off and she delivered without an episiotomy, but it was only because she happened to notice the needle in his hand and still had the wherewith-all to be able to question what was going on. 

The dentist had a similar story, although with a potentially more serious outcome had she not protested.  When she was three hours into active labor, she noticed that the two doctors – who had agreed to her natural-as-possible birth plan – were discussing the delivery right in front of her, but without involving her at all, and talking as if she weren’t there.  She heard them talking about prepping the OR.  She immediately questioned why they wanted to go to the OR.  They told her it was because she had been in active labor for three hours, and the baby hadn’t arrived yet, so the standard procedure was a c-section at this point.  She questioned whether the baby was showing any signs of distress, and was told that everything was normal.  So the only reason the docs were going to do a c-section was because the process was taking more than three hours.  She and her husband protested loudly, and within a couple more hours, they delivered a healthy baby boy. 

Recent data shows that over 30% of all births in the US in 2006 2005 were c-sections.  This number is a 46% increase from 10 years ago.  While there are absolutely times when a c-section is medically necessary, there are plenty of times when it is being used for convenience.  And we wonder why health care costs are skyrocketing?  Even small things like excessive fetal monitoring and episiotomies add a substantial chunk to the overall cost of delivering a baby.  Tack on a c-section and the bill can easily triple.  If this sort of blatant overuse of medical intervention is going on in obstetrics, one would assume that it probably goes on in other areas of medicine as well.  Nearly everyone agrees that medical treatment has improved overall health and life expectancy greatly.  And there are plenty of conditions that would certainly be fatal without intervention.  But when c-sections are being performed after only three hours of labor, with no signs of distress from the baby, it’s a sign that we’re misusing the medical system, and adding unnecessary costs to an industry already plagued with prices rising far faster than inflation. 

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

Comments

  1. Calli Arcale says

    A c-section because she didn’t deliver in *three hours*???? That’s positively absurd! (Even ignoring the sheer arrogance required to prepare for it without even mentioning it to the patient first — much less obtaining the legally neccesary informed consent. Makes me wonder just how far they were prepared to go in utterly disregarding her existence as a sentient being.)

    Three hours…. That might be a long time for a Hmong lady (they have a curious reputation for delivering startlingly fast — sometimes after only minutes of active labor) but I don’t think that’s all that unusual. Absurd…. No wonder the c-section rate is skyrocketing.

  2. Kris Bagiu, CPM says

    Hi there, I found you via Grand Rounds. I am a Registered Midwife in Colorado and deliver low-risk women at home. I think you may have a typo there on the Cesarean rate for the US since 2006 isn’t quite over yet; those are 2005 numbers. Appalling! It’s pretty standard in the hospitals of Colorado that birth is highly interventive and procedure oriented. The Registered Midwives have excellent statistics for our small population of patients served, which include vaginal births after cesarean (VBAC). Apparently we’re impressive enough to have caught the eye of the Board of Medical Examiners who’ve inspired this surgical mess and would like to see to it they limit the choice of women to give birth at home in later pregnancies following their cesareans. The information can be found here: http://www.dora.state.co.us/midwives/rulemaking.htm

    The rules are inspired by the director of registrations to appease the BME and further protect our clients, however the BME is using this opportunity to use their lobbying muscle to abolish the practice entirely. I don’t see anyone asking them to clean up their acts and protect women!

  3. Oops, thanks for noticing the typo – those were 2005 numbers. It’s sad that the OB/GYN world feels threatened by midwives and is pushing to eliminate the choices a woman has during childbirth. I suppose it’s easier and more timely for them to do c-sections as a routine practice. We plan to have our children at home, and I’d have to be in a pretty dire situation in order to want to give birth in a hospital. Thank you for choosing to be a home birth midwife and providing an alternative for all of us who would rather not be cut and poked and prodded during the birth of our children.

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