Mothers Denied Health Insurance After Cesarean Sections
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Mothers who have delivered their babies by cesarean section may face being denied the opportunity to attempt a vaginal birth with subsequent pregnancies. And now they are facing another obstacle: being denied health insurance.
Most mothers who deliver by cesarean section must usually deliver any future babies surgically, as more and more doctors refuse to take on pregnant patients who wish to attempt a vaginal birth after a cesarean, a VBAC.
Women who deliver vaginally after a cesarean birth are at a slight risk of a uterine rupture where the uterus splits open along the previous surgery incision - as horrible as it sounds and often fatal for mother and baby. The risk is very small and some doctors believe it’s similar to the inherent risks of major surgery, which is what a cesarean section is. Still, doctors don’t like being sued, and most insist that mothers have another cesarean section.
And now, private insurance companies are penalizing women who have delivered by cesareans, because if they get pregnant again, it’s likely they will need to have another cesarean.
In a story from the New York Times, mothers who delivered their babies by cesarean are being refused individual health insurance, or can only receive coverage by paying much higher premiums.
Health insurance companies are denying women coverage because the average cesarean birth costs a lot more than the average vaginal one. Surgery is more expensive, requires more doctors, more medicines and supplies, and a longer hospital stay, usually 4-5 days. The bill can run around $35,000. Mothers who have uncomplicated vaginal births usually get to go home the day after if they wish - $7,000 is a typical cost.
Insurance companies don’t want to foot the bill, so they are starting to make mothers pay, or denying them coverage altogether. In some states, this is illegal, but in many others, mothers are being discriminated against.
In 2006, more than 1.2 million cesarean sections were performed, and about half-a-million were repeat cesareans. It adds up to almost a third of all births in the USA. At the moment, only some individual insurance policies are denying women or asking for higher premiums, but if more follow suit it could have enormous financial and health implications for millions of women in this country.
The International Ceseran Awareness Network, ICAN, is a non-profit organization concerned about the rising cesearean rate in the USA. ICAN believes there are too many unnecessary cesarean sections performed for non-medical reasons, by doctors scared of lawsuits, or trying to make childbirth more convenient for them and hospitals. ICAN’s website has a front-page article on this story, and has letters for concerned mothers to write to lawmakers, and to their insurance companies.
The ICAN website also has lots of rsources for mothers who want to try for a VBAC, and links to local support groups.
Mothers who have had a cesarean birth: are you pregnant again and are fighting with your doctors for a VBAC? Have you seen your health premiums increase? What has been your experience?
Or are you reluctant to get pregnant again because of the necessity of having another cesarean?
Or are you lucky enough to have a supportive doctor for a VBAC? Please share your story!
Lissa says...
I had an emergency c-section with my son who’s now 8 months and I’ve spoken to my doctor about this because I’d like to have a 2nd child in the next few years. I suggested a VBAC at first and although she wasn’t really against it, she told me that if I only want one more to just go ahead and have the c-section to avoid the experience I had the first time around. I’m not really sure what I’ll do when the time comes. I am willing to do a VBAC but at the same time scared that it’ll take me 4 hours of pushing to no avail. She did however tell me the risks of having a c-section with too many children.
Jessica says...
I had an emergency c-section with my first child after 16 hours of labor. With my second child we opted to schedule a c-section. The scheduled c-section was much easier on me than the emergency c-section. The recovery was much quicker. My doctor was supportive of attempting a VBAC only if I would’ve naturally gone into labor prior to my due date. My second child happened to have had the cord wrapped tightly around one of her arms and there could have been serious issues had I attempted a VBAC. In my case I was lucky to have avoided a bad situation.
Science-mom says...
Oh, this is so unfair. I do agree than unnecessary C-sections should be avoided but there are mothers out there who didn’t have a choice. I didn’t because I was carrying twins and my OB thought a natural birth was too risky. He was probably right because one of my boys had low birth weight and breathing problems upon delivery.
Science-moms last blog post..Tough times ahead for big pharma?
Dawn says...
Well, I just switched (in my 23 week) from a hospital with a 45 PERCENT (YES, 45 % ) c-section rate to a hospital with a 10 percent c-section rate, and deliveries with midwives.
I was having some doubts because the new hospital is 40 minutes (with no traffic!) from my home, while my old hospital was 5, but this article just erased any doubts I was having. I also forwarded it to my husband.
Thanks for sharing this important news, brit!
Kimberly says...
I had an emergency c-section 6 weeks ago when my 10 lb. 4 oz. son wouldn’t come the “regular” way. I was induced because he was so large and then it didn’t work out.
I just had my 6 week check-up yesterday and told my doctor my husband and I are planning to get pregnant again at the end of my year-long recovery. She said, “Well, at least the mystery of how you’ll deliver your children is gone.” I told her I wanted to try for a VBAC and she said that if I keep having large babies I’ll continue to have to have c-sections.
I love my doctor, but am afraid now I’ll have to find a new one since she is being so conservative about c-sections… Though I do have some time to think about all this since I JUST had a baby.
brit says...
Thank you for sharing your stories. C-sections save the lives of millions of mothers and babies, but it’s awful that there should be a financial and health implication of having a c-section, in the many cases when it’s a medical necessity for a safe birth.
Naomi says...
I have had three c-sections in 2.5 years… that is right ladies… I have three children less than 2.5 years apart. I was on birth control with all of them and using condoms for back up protection… I love all of my children and wanted them all they just were not planned that close together. Anyway because I am a stay at home mom, and very young when I first got married and then pregnant I have always qualified for medicaid… not something I am really proud of but hey my husband and I got married at 21 (after he had served a two year mission) and was in college during my first two pregnancies and so we hardly made any money at all… (although we have tons of students loans we are paying off) and with the third one he was just starting out with his career so I haven’t had to pay a dime for any of my maternity coverage… unfortunately because I had three c-sections I cannot afford any health insurance now… my husband and I had even said well let’s just get a tubal or a vasectomy and use birth control and condoms, but we were told by the insurance we were looking at purchasing that they would not cover any sort of birth control but if I were to purchase the policy they also would not cover a c-section… now if you think it is hard to find a doctor who will let you have a vbac after one section imagine trying to find a doctor who will let you have one after three c-sections… I’m thinking it is impossible, and since my spouse and I are obviously so fertile what are we to do? Especially since since my first born was an emergency section at 8lbs 6 oz (born 40 weeks 1 day) after 19 hours of labor and being stuck at 9.5 centimeters for 6 hours, and several heart decelerations … my second born was 7.15 (and 4 weeks premature… I went into labor and was 7 centimeters within two hours but the hospital still would not let me do a vbac) my third was 7lbs 13 oz and also 4 weeks early… this time I was in labor for four days and when I finally got to the hospital for the 50th time I was almost 9 centimeters and fully effaced but I was told basically to squeeze my legs and hold the baby in and resist the urge to push so the surgeon and anesthesiologist could get to the hospital and scrub in… they absolutely would not allow me to push and I was threatened to be dropped from my ob’s office if I didn’t listen… talk about being strong armed. Now I am stuck in between a rock and a hard place because I would like another baby but insurance companies just laugh when I tell them I have had three c-sections… now granted my doctor says I have a small pelvis (although you couldn’t tell that by my jeans) and I do tend to have large for gestation babies, but is it really fair to be told no the hospital will not allow a vbac and the insurance company won’t pay for one??? And even if we decide ok we won’t have anymore children, how are we, supremely fertile adults supposed to stop that from happening if the insurance company won’t pay for any type of birth control? Obviously I need something besides the pill and condoms (which I took my pill religiously at the same time everyday, I had an alarm set and everything)… and what happens if I get pregnant again and since my husband is now out of school we don’t qualify for medicaid? He might be working now but we can’t afford the cost of surgery… I would like to try a vbac, in the hospital though since I have had three prior c-sections and since I have large babies… if I get insurance and find a doctor/hospital willing to do a vbac and something goes wrong and a c-section is medically necessary can the insurance company still refuse to pay it? Would I just have to file bankruptcy if I couldn’t afford it? I don’t want to go someplace like planned parenthood for a sliding scale birth control just because I do not support abortions (except for in the case of rape, incest, or the mother and or child’s life is in peril and then after only serious pondering and prayer) and I don’t want any of my money to support abortions… Anyway this has been way long but I was just curious other people’s thoughts…
Dawn Allcot says...
Naomi, I would pay the money to get your tubes tied or have your husband have a vasectomy. In the long run, that will be far less expensive than another child, which you clearly can’t afford. (And I get the impression from your post that you would not want a fourth, anyway). Even if you had to pay for a different, stronger birth control pill, that too would be less expensive than another child. I wonder how you think it is less expensive to raise a child than to *prevent* pregnancy, even with no insurance?
Brit, great article! I suppose I shouldn’t be posting my opinions on c-sections and vbacs, as I’m having my first child and *plan* to have a completely natural childbirth, drug free and intervention free. In fact, I just switched from a hospital with a 35 percent c-section rate to one with a 10 percent rate and midwife delivery!
I feel so good about my choice, and when I read this report from the Times (which came out the day of my first appointment with my midwife, ironically) I felt even better about it.
I think this is just horrible that healthy women can be denied coverage for a *necessary* medical procedure. Granted, I feel like physicians are far too eager to perform c-sections for one reason or another (fear of malpractice, overcrowding in delivery rooms, doctors changing shifts and wanting to get a delivery “over with”), but in cases where it is medically necessary, women should not be penalized.
It’s terrible and publicity and education is the first step toward positive change. I hope I-CAN (a great organization!) is successful in lobbying against these ridiculous insurance regulations that discriminate against women.