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OB/GYN's Admit Money Drives C-Section Rates?

Its all about the Benjamins for a group of OB/GYN’s and hospitals in Tennessee who have now openly admitted they will consider dropping TennCare patients if the government in the state continues lower insurance reimbursements for cesarean section deliveries.

In an effort to help lower the rate of unnecessary c-section deliveries, TennCare, the medicaid program for pregnant women in the state has proposed big changes.

Under Gov. Bill Haslam’s proposed spending plan for next year, hospitals and obstetricians would get only half of what they now receive for C-sections. The change is projected to save $14.9 million, accounting for more than one-third of the overall cuts to TennCare.

But in disagreement are many providers across the state who have openly come out and said if this happens, they will stop accepting TennCare patients altogether, leaving less options for pregnant women to get proper prenatal care.

But what gets me most about it all is, finally there is a group of OB/GYN’s coming out and saying what many have been suggesting in the birth community for ages… money drives the number of c-sections that take place.  An extremely doctor friendly procedure that takes 45 minutes, and of course they are home for dinner, when compared to long on call hours with laboring mothers, missing birthday parties, and golf games.

Dr. Wendy Long, the chief medical officer for TennCare, gave both financial and health policy reasons for the change during the governor’s budget hearings.

“C-sections are considerably more expensive than non-C-sections,” Long said. “In many cases, they are absolutely necessary, but in other cases the C-sections are more elective in nature, so we hope to see a reduction in elective C-sections.”

Unfortunately for Dr. Long, the World Health Organization does not believe that most of these c-sections are necessary, and organizations such as The National Institute of Health, and the American Congress of Obstetricians and Gynecologists have been working together to find ways to lower the c-section rate across the country, because of the sheer unsafe number of surgical deliveries taking place annually.

But the issue goes even deeper.

But that increase does not mean that the surgical deliveries were elective, said Dr. Janice E. Whitty, chief of obstetrics at Meharry.

“It is very true that the rate of cesarean deliveries is increasing, but it is not increasing just because of convenience. It is increasing because of the repeat cesarean deliveries that occur,” Whitty said. “Many doctors now don’t want to face the liability of doing a vaginal birth after a cesarean section.”

A vaginal delivery after a mother has previously given birth through a C-section carries the risk of a uterine rupture, which can result in death of the mother or the child.

Unfortunately what these big news stories are not mentioning is the rate at which uterine rupture takes place in healthy low risk mothers with previous cesarean deliveries, which is 0.6%… less than a 1% risk. A risk that should be up to the mother to decide if she wants to take, or consent to for delivery… not restricted because hospitals or providers simply will not provide a service that is the safest option for mothers and babies in the vast majority of cases.

With this, we are also seeing a huge issue of lack of access to vaginal deliver after a previous c-section across the country. It is estimated at at least one third of hospitals in the country will not allow a VBAC (although denying VBAC to mothers is not legal) leaving no options for mothers but a repeat c-section.

Overall, the true colors of OB/GYN’s and hospitals have shined through on this issue!

photo: flickr.com/AMagill

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