Portland hospitals banning elective c-sections and early inductions

[Hello_Again]

@lorene

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.

I am not necessarily saying that’s in any way wrong. I am contesting the idea that somehow this move is a positive for people with particularly assholish employers. It is a real stretch to say it is.

You know, I have a REAL hard time believing 40% of orgeon births are covered by Medicare. Why? because Medicare exclusively serves the population over 55. Medicaid serves the low-income population. Frankly, with quality reporting like that the entire article is thrown into doubt. However, even if 40% of Oregon births are covered by Medicaid, Oregon is free to stop covering elective c-sections under Medicaid if the cost is burdensome. Private insurance companies have the same choice. I’m not really sure why controlling women’s choices at the point of service is the better answer.

[Kent_Clark]

@lorene

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.

The proper way to decide if a procedure is medically necessary is to review it and the doctor who performed it. If it turns out that a particular obstetrician is inducing labor or performing C-sections of dubious medical value, then you discipline the doctor. The idea that every hospital in an area can get together and require every obstetrician to get approval for every decision in advance either means every obstetrician in Portland sucks, or the hospitals are going way beyond CYA.

[lorene]

@kunilou

The proper way to decide if a procedure is medically necessary is to review it and the doctor who performed it. If it turns out that a particular obstetrician is inducing labor or performing C-sections of dubious medical value, then you discipline the doctor. The idea that every hospital in an area can get together and require every obstetrician to get approval for every decision in advance either means every obstetrician in Portland sucks, or the hospitals are going way beyond CYA.

Couldn’t it also mean that doctors are getting pressured unduly by patients who want to schedule births and this is a way of addressing that? That’s a genuine question. I think there are other possible scenarios besides your either/or options. In fact, I’m willing to bet that this is in response to a number of issues, not just one issue.

[Steophan]

@Dangerosa

I’m assuming that these hosptials will stop doing all medically contraindicated procedures that carry risk but aren’t necessary. No more plastic surgery. And they’ll tell people who want gastric bypass to go for the natural method because gastric bypass carries risk and they could loose weight without that risk.

One would hope so in all cases. Plastic surgery should only be available if necessary for health reasons (mental or physical), the same as weight loss surgery.

There’s no way that hospitals should schedule a birth for the convenience of the mother when it increases the risk to either her or the child. The same should apply to all medical treatment - it should be the best available, not something “convenient” that is, in fact, more damaging.

[JohnT]

My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask. And no, it wasn’t medically necessary, and it was done for convenience:

Enter hospital: 6:00am
Induced: 7:30am
Contractions start: 11:00am
Baby born: 1:30pm

Awesome. And this was for the first (so far, only) child.

To be honest, I’m completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of “women’s bodies, women’s choices”.

You can decide to kill your child, but you’re not allowed to decide as to when to give birth to a child? There aren’t enough :rolleyes: in the universe for such a logical disconnect.

[lorene]

@JohnT

My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask.

To be honest, I’m completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of “women’s bodies, women’s choices”.

You can decide to kill your child, but you’re not allowed to decide as to when to give birth to a child? There aren’t enough :rolleyes: in the universe for such a logical disconnect.

How many weeks pregnant was she? I am not anti-induction at all. I am “anti-taking the baby out weeks before it is ready to come out”. I don’t necessarily agree with the 39-week cutoff here, but I have known many a 36- or 37-week pregnant woman, uncomfortable and sick of being pregnant, who gets upset when her OB won’t induce, despite there being no medical reason for it.

[perfectparanoia]

@redtail23

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.

I don’t think these women are doing this because they have to or they will be fired for it (since FMLA in your country would prevent that and we have laws here to do the same). I think we are talking about career oriented women who don’t want to end up on the ‘mommy track.’ They know that they will (subconsiously, at least) be compared to the career oriented men in the company who will often come in the day after their wife has given birth (or stay at the office until the last moment).

Honestly, I probably work for the most family friendly workplace out there (if the kidlet is sick, I just fire off an email. If there is a doctor’s appointment, I just put it in my calendar and I make personal calls all the time). However, all the top jobs go to the people who can get on a plane at a moment’s notice (usually they have stay at home spouses since they all do seem to have procreated). That’s just how it is. To do their jobs, you have to be able to, well, do their job (which means being available often on short notice).

So, I won’t have a top job at my company since I can’t do that. I could rearrange my life to do so but I choose not to. If I had one of those jobs, you can bet that it would be tricky to carry a pregnancy to term, give birth and some how recover fast enough to be back before my career was damaged.

[JohnT]

@lorene

How many weeks pregnant was she? I am not anti-induction at all. I am “anti-taking the baby out weeks before it is ready to come out”. I don’t necessarily agree with the 39-week cutoff here, but I have known many a 36- or 37-week pregnant woman, uncomfortable and sick of being pregnant, who gets upset when her OB won’t induce, despite there being no medical reason for it.

“Naturally”, Sophia was due to be born in a few days.

[redtail23]

[hijack alert! hijack alert!]

See, here’s the thing.

Everyone moans about skyrocketing medical costs and malpractice costs. But the minute someone does something to combat risk and costs, everyone starts bitching.

Something like 15+ years ago, Oregon’s Medicaid program (whatever it’s called; I also wondered just how many deliveries Medicare was paying for :p) decided that they would no longer pay for extreme medical care for very premature babies.

It seems that they could provide pre-natal and infant care and support for 50,000 regular babies with what they were spending on one of these extreme cases. They decided that preventing problems in 50,000 kids was more effective than treating one child with low chance of survival.

I applauded that decision. At the time, I was working in Medicaid billing for similar cases. There are lots of these kids that never leave the hospital. Surgery after surgery after surgery, ICU, various life supports, etc. A few make it for some time - a couple of the kids I saw were 6 and 7 years old and still living full-time at the hospital, maybe with occasional brief visits to their families. A very few make it home (I think the average is something like 17% survival rate) and many of those have severe disabilities - which means, again, that Medicaid is on the hook for the rest of their lives.

I think the policy lasted a couple of months before it was retracted due to overwhelming public outcry about this horrible, evil, horrendous and callous decision.

So you really think that Medicaid or an evil, profiteering insurance company is going to be able to get away with making this call regarding unnecessary early inductions/c-sections? If an insurance company had done this, you’d all be screaming the exact same things about patient rights and women’s choices and all of that.

In Utopia-land, parents could sign a release saying that the risk and responsibility was all theirs, and then they could do whatever they wanted. They wouldn’t be able to get insurance to pay for it, or hit Medicaid up to cover costs for their disabled child, or sue the hospital and doctors because they wanted to blame someone for their own choices.

But we don’t live in Utopia land, and the fact is that these parents aren’t taking the risks and responsibility for their own choices.

And now y’all are throwing fits because some hospitals decided to control their own risks and reduce costs. Because somewhere, some parent might not get everything their own way.

And then you wonder why we’re in such a mess in regards to healthcare.

[/hijack]

[Kent_Clark]

@lorene

Couldn’t it also mean that doctors are getting pressured unduly by patients who want to schedule births and this is a way of addressing that? That’s a genuine question. I think there are other possible scenarios besides your either/or options. In fact, I’m willing to bet that this is in response to a number of issues, not just one issue.

I think a doctor should be able to tell a patient that what she wants is medically inadvisable and an unnecessary risk. If there are no obstetricans in Portland who can do that, then it’s a much bigger problem than a blanket policy can cover.

[redtail23]

@kunilou

I think a doctor should be able to tell a patient that what she wants is medically inadvisable and an unnecessary risk. If there are no obstetricans in Portland who can do that, then it’s a much bigger problem than a blanket policy can cover.

Well, this blanket policy seems to have covered that problem.

Seriously - should the doctor be able to refuse the patient’s request? Or is s/he required to perform an unnecessary and risky procedure, because that’s what the patient wants?

[redtail23]

@JohnT

My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask. And no, it wasn’t medically necessary, and it was done for convenience:

To be honest, I’m completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of “women’s bodies, women’s choices”.

You can decide to kill your child, but you’re not allowed to decide as to when to give birth to a child? There aren’t enough :rolleyes: in the universe for such a logical disconnect.

@JohnT

“Naturally”, Sophia was due to be born in a few days.

So, once again, this ban would not have affected you. The ban is against EARLY unnecessary inductions.

[JohnT]

@ScarletKnights

It isn’t all about you.

Also, anything to reduce people scheduling births around their work schedules, the better. Work to live, not live to work.

It’s not all about your opinion of others lifestyles. :rolleyes:

[doreen]

@Dangerosa

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.

IANAL, but I don’t it’s that simple. You can certainly accept the risk for yourself, but if the child is handicapped as a result of the c-section or induction (or the timing of it) , the fact that you signed off on it won’t save the the doctor or the hospital when the child grows up and sues or even when the father sues on behalf of the child.

[lorene]

@JohnT

It’s not all about your opinion of others lifestyles. :rolleyes:

Says the guy who summed up the pro-choice stance as “you can decide to kill your child.” I agree with what I quoted above, but…come on.

[ecseas]

@Hello_Again

Great post, I totally agree. This banning is shameful and ridiculous. What if a woman elects c-section or induction because it is beneficial to her career, education, or the needs of her other children? Guess she’s just fucked then. Thanks a heap, Portland!

If a mother has to schedule her baby’s birth around her career, how is she supposed deal with unexpected mishaps that happen with children? If her career is so important that the birth has be fitted around it, I wonder how much attention their poor kids will get…

Things come up with children. They get sick, they get hurt. You will have to take time off to look after them. If you can not afford to take time off/ it’s frowned upon to take time off to give birth then it will definitely be frowned upon to leave work early because Junior needs to go to the hospital, because he fell and broke his arm.

I might be missing the point or I might be old fashioned or something, but if your career is more important then your child’s birth, maybe having a baby isn’t really going to fit with your lifestyle. I have nothing against working mothers, but I believe children should be more important then your job ( to a certain extent)

[Shmendrik]

@Sattua

I’m a little bewildered when I read about all of these elective births, quite frankly. I live in not-very-progressive Illinois and, without medical recommendation (such as twins, a very large baby, etc), my hospital will not induce before 41 weeks 1 day. They also won’t schedule a c-section for a woman who has had only one previous c-section. You have to do a trial labor.

I think that’s specific to your hospital. AFAIK patients can have (effectively) elective inductions at 39/0 in Illinois.

[perfectparanoia]

@ecseas

If a mother has to schedule her baby’s birth around her career, how is she supposed deal with unexpected mishaps that happen with children? If her career is so important that the birth has be fitted around it, I wonder how much attention their poor kids will get…

Things come up with children. They get sick, they get hurt. You will have to take time off to look after them. If you can not afford to take time off/ it’s frowned upon to take time off to give birth then it will definitely be frowned upon to leave work early because Junior needs to go to the hospital, because he fell and broke his arm.

I might be missing the point or I might be old fashioned or something, but if your career is more important then your child’s birth, maybe having a baby isn’t really going to fit with your lifestyle. I have nothing against working mothers, but I believe children should be more important then your job ( to a certain extent)

And that’s where your spouse comes in quite handy. It has worked the reverse way for decades (that dad was not expected to deal with such things) so if the woman is the high flying career type and the man is not, the dad deals with all these things.

My mom did all that stuff when I was a kid (with some backup from my grandma). I can’t think of a single time my dad left work early or took me to the hospital when I injured myself (which was frequent). He would get home from work and check on me but it would be at a normal time.

[Mama_Zappa]

@Lasciel

My boss’ daughter-in-law is a CFO of some huge financial corporation, and she’s had two kids so far. The first was when she was angling for the CFO slot, and the second one just a few months back.

She scheduled both births for a Friday evening so she could be “recovered” and back at work on Monday morning. Apparently the corporate culture mavens informed her that if she missed any work for any form of motherhood-related activities, she’d be straight onto the shit-list, and apparently she wasn’t interested in finding out if it was true.

I am usually all for free will and lots of choices, but I really don’t think that should be necessary or encouraged.

Yikes. I can’t imagine being capable of working less than 72 hours after giving birth, with either of my deliveries.

What’s frustrating is that if a guy were in the same position, he’d have been expected to miss at least a couple of days - good family men are good for business, dontcha know, and wifey needs his support (but only for a couple of days of course!).

The OP premise is an interesting one. The real question is how do the hospitals determine whether it’s early / elective? Do they have a review board? Does the attending OB have to submit documentation on why the induction is scheduled / C-section is requested? There are, after all, lots of legitimate medical reasons for both.

Not that I think it’s a bad idea, just curious as to the logistics.

Also, it’s hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I’ve never heard of anyone saying to the doc “Let’s skip this whole labor bullshit and do some surgery!”.

[pbbth]

@Mama_Zappa

Also, it’s hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I’ve never heard of anyone saying to the doc “Let’s skip this whole labor bullshit and do some surgery!”.

I did.

I don’t do medical stuff well. After performing my colposcopy in January and then watching me cry and scream while having blood drawn when they verified I was pregnant and needed to run some tests I told her I didn’t want to give birth and that I wanted a cesarean. She agreed and said that quite frankly she didn’t think I would be able to handle a standard labor. I am not going to be happy or comfortable with the birthing process no matter how it happens so I might as well get it done in less than an hour (and get a tubal while she is at it so I don’t have to do it again in the future) than spend between 4-48 hours being terrified of everything and everyone around me. It was also discovered that I probably have cervical cancer right now as well so I would rather my cervix be up for a scraping and potential cell removal as soon as possible rather than having to wait for everything down below to heal up before they can remove any dangerous cells. It will take longer to recuperate and I am fine with that because to me the benefits of a cesarean outweigh the drawbacks significantly.