Does the “hosptial” perform any procedure? I thought the DOCTOR performed the procedure. I thought that the DOCTOR/PATIENT relationship, not the PATIENT/HOSPITAL relationship was primary.
More importantly, I have a problem with that patronizing attitude of “we are going to protect you and your baby from yourself.” Frankly, if they are going to do that - they’d better be consistent and the hospitals better not do any cosmetic or elective surgery - because there is always risk.
Well, the hospital has to supply the staff, the facilities, and any needed materials and medications. In the event of a C-section, that includes an OR which, at least where I work, can be very difficult to book.
And again, I don’t think this is all about risk. It is also about skyrocketing healthcare costs. A C-section is expensive, but generally covered by medical insurance. Elective cosmetic surgery may be expensive, but it’s an expense put on the patient.
If their only rule is that they will not allow an elective birth that is being done before the baby is properly developed I can see that as being okay but the 39 week cutoff is a little bit much. 38 weeks would be a much better cutoff date and it would be better still if they allowed women to have a sonogram or other exam to verify that the lungs and everything are fully developed if she wants to have an earlier birth scheduled.
An elective birth is one of many decisions a woman will make regarding her child’s health and well being. We allow people to choose not to vaccinate their kids. We allow people to choose whether or not to circumsize their sons. We allow people to pierce the ears of a newborn baby if they want. People are going to make decisions we don’t always agree with regarding their children and their reasons are not always going to be ones we will understand.
Than the insurance company should be saying we don’t cover it. And the hospital can say “sure - but we want you to pay up front.”
If the woman can pay for it, the doctor will do it, and the woman wants it - shouldn’t they be the ones accepting the risk?
Moreover, this isn’t one hospital saying “we aren’t going to do this anymore” - they got together to remove this choice for Portland area women. That’s really patronizing.
I get what you’re saying, I really do.
As someone who works in a large city medical center, I can almost guarantee you that this is not the type of decision that was entered into lightly, though. Hospitals do not take actions which will result in a loss of revenue without some really good reasons. Moreover, hospital administration is generally largely made up of physicians, nursing officers, and those with advanced degrees in public health. I have to think that if all of those people in seventeen hospitals were able to reach an agreement on this, it was in response to some very real issues and concerns that they have about the current climate surrounding births in their community.
That said, there may be changes coming up in the reimbursement system that dictate how hospitals will be reimbursed for interventions that are not considered medically necessary. I don’t know. I do know that performance-based reimbursement is something we think and talk about a lot at the medical center that I work in, and it’s possible that this is the harbinger of something larger than some hospitals getting together to stop non-medically necessary C-sections and early inductions. But that is wild speculation on my part.
I could definitely get behind this. The “due date” is such an iffy thing anyway, I also have some problems with the hard-and-fast cutoff date. I also wonder if it won’t just lead to docs/patients ‘fudging’ the due date.
There is also a risk to the hospital. When people sue for medical issues, they tend to sue everyone in sight, especially the deep pockets.
Doesn’t the hospital have the right to manage their risk? Even if they all decide to cooperate to do so?
I just KNEW someone was going to say this. Goldurn wimmin wantin to work when they should be birthin’! Perhaps the father intends to be the full time caregiver, ever consider that? And maybe it’s none of your damn business what they plan to do. Yeah, I’m pretty sure it’s that last one.
Are we now means testing whether someone is wealthy enough, or has the “right” kind of job before they’re allowed to have children?
I don’t believe they have the right to collude with other hospitals in managing risk. Each hospital in the Portland area needs to make that decision independently.
And I believe that where risk is reasonable, their should be the ability for the hospital to have the woman sign off on the risk and accept it. And I think in the face of that signature, it should be DARN HARD to sue a hospital unless there was egregious malpractice.
And I believe that you need to be consistent. If you are worried about getting sued due to elective procedures, you shouldn’t offer them. If you are going to let a women get a boob job for cosmetic purposes, but not let her deliver at 38 weeks because she lives an hour outside of Portland with no near hospital and her husband travels a lot, that’s patronizing. You may be controlling your risks, but the woman should also be controller HER risks. Her risk might be “my husband will be out of town and there is a good chance I won’t be able to get to the hospital during week 39 or 40 if I go into labor.”
Oh get over it. It’s not like I’m actually saying that to an individual, it was a snide aside on a message board.
And I’m sorry, I’m not talking about your average working couple, here. I know plenty of working couples, some of whom chose to have one parent stay home, some of whom opted for both parents to keep working. My Bro-in-Law is a stay-at-home dad.
I don’t know ANYONE who had to schedule the birth of their child early in order to keep their job. I don’t know ANYONE who would even consider having an over-the-weekend-no-time-off birth because “miss[ing] any work for any form of motherhood-related activities would put [them] on the shit list”.
My parents both worked when I was a kid; I was that horror-of-horrors a latchkey child. Back in the 70s, when that was a major bugaboo. So were most of my friends. We all turned out fine. I got nothing against working parents.
But according to Crown Prince, in Portland the pressure is not only to schedule early births to work around the mother’s job, but also the father’s. So hey, why not schedule the birth at 5 months, when it’s slack season for business, hmm?
Apparently some of y’all think that it’s great and fine and dandy that businesses are now coercing employees into risking their (and their children’s) health because hey, it’s all about your personal freedom and convenience. And any sacrifice for a career is golden.
Some of us disagree.
No, I think if the employer is the one doing the coercing, the employee is not the one who should be punished.
I wonder how you think this change will impact the employer who sets the rules negatively? The idea that you’ll sock it to those mean employers by forbidding employees from complying with their policies, is an… interesting one. Shouldn’t you actually forbid the employers from having those policies?
AND? Here I’m pressing my own beliefs a little, but for the sake of argument, if at five months I am willing to pay for and accept all the risks involved in a pre-term birth - its my body and its my child.
(I think in that case we’ve crossed the line from “37 weeks is full term and the risk difference between 37 and 39 weeks is negligible” into “child endangerment” - but I don’t know what that line is. However, I’m pretty sure that line is at least at a full term 37 week birth.)
Speaking of bullshit.
Some of us don’t think it’s dandy for any business to coerce anyone into making medical decisions that primarily benefit the business.
Funny how that works, ain’t it?
I can see reasons why the hospitals would choose to do this en masse, but I’d be speculating so I’m not going to. Regardless, that decision is theirs. It may be patronizing, as you feel, but you’ve got no right not to be patronized, hmm? If you want that conveniently scheduled 36 week c-section, go somewhere that offers one. These hospitals have decided not to accept the risk that is created by unnecessary early deliveries.
You can believe all you want about signing risk releases. The reality is, they don’t do jack. I wish an actual lawyer would come in here and explain this to you. Idealistically, this idea would work fine. In the real world, where obgyn malpractice rates are sky-high because people now sue for any and everything imaginable anytime they’re unhappy about anything remotely related to the pregnancy, birth, postop, or the actual child - that’s not how it works.
Risk of malpractice suits are much higher than the risk for cosmetic surgery, therefore it’s consistent for the restrictions to be higher also.
But I’d agree with you that there should be more leeway in their cutoff. Which is why I liked kunilou’s suggestion.
I doubt there are actual policies. This kind of stuff is usually done one the nudge-nudge-wink-wink level. I’m pretty sure they wouldn’t get away with an actual official policy.
But if NONE of the employees can get early-scheduled deliveries because the hospitals won’t do them, it kinda takes thre pressure of, doesn’t it?
It’s like having a subpoena delivered to someone who wants to testify but is worried about backlash. “Oh, look, not my choice, gotta do this, sorry!”
IF you are willing to take those risks AND there was actually (in the real world, not utopia-vision) some way to enforce that willingness, both legally and financially, then fine. But it’s not that way now, so that’s a really a meaningless point.
Yeah, I know, I was exaggerating with the 5 months thing. Sue me. 
Well, I’d have to agree with you there. And what is the price of tea in China these days, anyway?
No, it just makes having children a career-killing decision rather than one you can work around. There will always be childless people availble to fill those jobs. People with children will simply be let go because “they had too much unscheduled absence.” They might also “lack the committment and flexibility” for management level positions. Etc. You have quite the rosy view of what a company, one which is already dickish enough to pressure its employees on major life decisions, will do.
“One Sick Child Away From Being Fired” a report on employment law by Hasting College of Law that focuses more on working class job sites, is quite the harrowing read.
The second-to-last paragraph in this article refutes the idea that an elective C-section is comparable to elective cosmetic surgery.
The article itself discusses risk as compared to vaginal delivery.
In the interest of balance, this page offers a side-by-side commentary by a pro-elective C-section doctor and an anti-elective C-section doctor.
But again, it’s not up to a doctor or a hospital to fix that. A hospital is concerned with the health and safety of mother and baby, with providing care in the most efficient manner possible, and with the fact that the cost of an elective C-sectionis 76% higher than that of a natural birth. The article I linked to, about these very hospitals in Oregon, states that one hospital reported a yearly savings of $1million as a result of banning elective preterm c-sections. The fact is also reported in that article that 40% of Oregon births are paid for by Medicare, although it does not state how many of those are in Portland.
Interestingly, I found a similar policy propsed in New South Wales. Not sure if any of our Australian Dopers care to chime in on this.
No, actually, I quite agree with you.
Hence my comment earlier about having kids when you’re working a job that doesn’t allow for it. If you can’t even take off work to give birth, then when are you going to ever have time for a parent-teacher conference or school activity? Or a sports event or recital or school play?
All the parents I know take off work for those events, at least occasionally, even when there’s a stay-at-home or other provision for sick kids, school closings, etc.
I know people who have quit their jobs and figured out how to make do on one income, because it was important to them to have a stay-home parent.
I know people who decided that staying home wasn’t for them, and figured out how to balance work and family, even if it’s not perfect.
Whatever works for you.
I just don’t understand how it works having kids when you’re in a job or career that is so anti-family that they’d push all employees to schedule births based on business schedules. Even the places I know that are horrendously uptight about taking off with sick kids, etc., don’t expect that.
But really, this is all a bit of a hijack based on one smart-ass comment, neh?
Other than the fact that the Portland hospitals just may have taken the work culture into account when making this policy. Or they may not have, we don’t really know.