At the Capitol / Health bills favor birth centers over hospitals
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#1 Apr 5, 2009
I am opposed to the legislation for several reasons:
First, these centers offer no sedation for the mother. I had 2 kids without meds, however, one of my births was particularly bad. Not all women are equipped to manage their pain on their own. If they are forced to go to these centers, they have no options on pain control. In some sense, you could equate this to a form of torture. Surely we have progressed beyond this position? Taking all choice away from a woman and then forcing her through childbirth without meds? Barbaric.
I think that there's more to it, however, than having dr's readily available. What it does is disallow a woman pain medication- these centers specifically do not use meds. I can remember being sent home on the 24 hour rule, however, I had suffered partial organ failure (kidneys) due to excessive bleeding & resultant shock. I had no idea that this had happened- no one told us until one week later. This decision to send me home was all about complying with the insurance company "rules" on 24 hour stays, not my health. In this case, women have no choice for meds, they're forced to go to these centers if one is available. I'm sure that it will be enforced and women of all income levels will be forced to go thru childbirth med-free whether they want to or not as long as they are "low" risk. When/if that occurs, you can bet that legislators are going to get an earfull of comments. I'm perfectly ok when women choose to go this route, however, I am not ok with the lack of choice. When personally faced with this situation, I would bet most women wouldn't like it.
Second, it singles out the poor. The article specifically notes that women on assistance programs will be moved into this program. I understand the need to reduce healthcare expense, however, at what cost to new mothers?
Third, birthing is one of the most uncertain of human processes. In other words, there are any number of complications that can result even for those that are thought to be low risk. Let me give another of my own examples: When my water broke, it was found that the baby had passed a bowel movement in utero (meconium stain). My labor progressed very quickly and a team of neonatal specialists had to be present for the birth because during the birth, once her head had come out, she had to have her lungs suctioned. If she had contracted the pneumonia that is associated with this event, the death rate is 50%. There is a 30 minute transport provision attached to this part of the healthcare bill, it's not going to work in every case because we all know that some women can have a baby very quickly while others take more time. If this is the case, babies and mothers could die.
Fourth, malpractice insurance for obstetricians is extremely high, nurse midwives are also under the same microscope. THe author of this bill would do well to do some research and see if this option is really doable.
Fifth, it singles out women, what about men? There is no equivalent to childbirth's pain, what could possibly be an equivalent for a man without meds, a kidney stone? Aren't there enough constraints on women and their healthcare in general and particularly poor women? I am honestly appalled at the bill and that it is sponsored by a woman, a Democrat at that.
Saint Paul, MN
#2 Apr 5, 2009
Why? What makes you think democrats care about you? They don't care about individuals, all they care about is the system, and this system is more "efficient" don't you see.
#3 Apr 5, 2009
Thanks for weighing in Janet, and I am sorry that you view natural childbirth as "torture". I am interested in seeing this bill passed because of the options that it will open up to women, not mandate them into care that they are not comfortable with.
Most women now, who want a natural birth, are virtually mandated to go to a hospital, armed with a narcotic-free birth plan, only to fight nurses, drs., and anesthesia personnel tooth and nail to achieve a drug-free birth. They are then hooked up to constant fetal monitoring, denied food & water by mouth, and constrained in even the physical position that they push their baby out in. What is more "torturous" to you?
Believe me, the drugs will always be available in the hospitals for those who want them. If you want statistics on why epidurals (narcotics taken for pain in birth) are risky to the health of the mother and baby, they can be found here:
My midwife once told me that she has never had to take a woman to a hospital because they "needed" pain medication. When a woman is choosing her birth, and is educated, there are plenty of ways to manage labor pain that do not include narcotics and morphine.
I am not in favor of our government mandating where a woman chooses to give birth, but to think that the uninsured and MinnesotaCare Moms will have LESS choices, not more, is absurd.
Your comments echo the popular sentiments of birth in our country - that is something to be feared.
I myself do not have health insurance and pay out of pocket for health care expenses. I live 2 blocks away from the Mayo Clinic in Rochester, and have three kids, all born at home. My fourth baby is due in June, and I am planning another drug-free, physiological process to occur. If I have complications, I have a back-up plan. I just would never choose to have a natural birth in a hospital setting. To me, that would be torture.
If you believe that I am engaging in risky behavior, outcomes on out-of-hospital birth vs. hospital deliveries can be found here:
If you are a low-risk, healthy woman, your chances of coming out of your birth scar-free with a healthy baby are a lot greater if you stay out of the hospital.
US hospitals have a 30% C-section rate, while only 3% of homebirths that are transported to a hospital, result in a C-section. The recommended C-section rate by the World Health Organization is approx. 13%. That means a lot of women are being needlessly cut open.
It's also a lot cheaper ($3-4K vs.$10-15,000) for an UNCOMPLICATED delivery (i.e no meds, no C-section)
But maybe that's what the opposition to this bill is really interested in?
I would just like to see ALOT more women in Minnesota realize how powerful they really are, and to take charge of your healthcare! Call your legislators, this is truly a non-partisan bill that would create a more options for women all around our state.
There are only 2 states in the union that are without free-standing birth centers. Minnesota is one of them. Let's change it!
#4 Apr 5, 2009
I'm sorry you see the bill as a mandate rather than an incredible option. Most insurance companies have specific restrictions on people choosing home birth. It's an idiotic rule manipulated by greedy hospitals. The American Academy of Pediatrics and the American Academy of Gynecology both frown on out of hospital birth because if the truth gets out that it's safer and actually empowers women, rather than humiliating them and women start choosing it they will lose the majority of their "easy money." I don't know if you've heard of the movie "Born in the USA" but it really strips America's broken maternity system down and bares the truth about the harm that mothers and babies are coming to in America. Check out the WHO and see the statistics on infant mortality and maternal death rate in America. It's crazy. The problem is that intervention causes casualties. It's unfortunate but true. The other problem is that poor women DON'T get the same level of care, women are NOT educated about the importance of healthy diet during pregnancy and this bill want's to change that. Midwifery care is superior for low risk pregnancies across the board. My hospital birth disempowered me, hurt my baby, hurt me and left me empty and searching for the answers. I found them in midwifery care with my next baby. The transformation of who I am, came from the education, the belief in God's divine plan in birth, and the realization that I was "made for it." I'd be so traumatized to ever have a hospital birth again that they might have to lock me up. I've been to births in 3 hospitals as a doula and the things I see them do to women is criminal. The worst part is... the women know it.
#6 Apr 5, 2009
If Minnesota were a country, our infant mortality rate would be 33rd in the world, behind Singapore, Malta, Hong Kong and of course all of Western Europe and Japan. Minnesota's rate is more than double some European countries. So if one is worried about dead babies, then we need to change the way we give birth and care for birthing women and newborns. Just about every country with decent medical care does better. In Minnesota and the US, the babies are dying in hospitals, and at an unacceptable rate.
Women have too much pain in childbirth in the US., I agree. Pain is related to the hormonal progress of the birth, and to the psycho-social circumstances surrounding the birth. Women and their partners are left alone for long periods of time, are uneducated about how to manage pain and how to keep their labor progressing, and are deluded into thinking that the narcotics given in hospitals are without serious side effects. Birth pain is manageable for most women if they are well educated, well prepared, and familiar with the twenty or thirty non-pharmacologic methods to manage labor pain and keep labor progressing smoothly. This is not learned while in labor, but must be learned and practiced ahead of time. Women also do better with continuous support. Women who have doulas or out-of-hospital midwives have up to 50% fewer cesareans and up to 60% fewer requests for epidurals. Most physicians and many midwives are not able to apply non-drug methods of pain relief because they aren't trained to do so, and because they don't stay with women continually throughout labor or cultivate personal relationships with their clients. The system we have doesn't let them.
Also, the midwife who delivers your baby in a birth center has met with you for many hours prior to birth, comes to your home following the birth, often several times including the next day. Not a half hour visit from a nurse because you left early, but all the time you need to feel secure and informed about the next steps in your recovery and your parenting.
And it cost less, whether insurers or the state or you yourself are paying out of pocket.
Of course, women with unmanageable pain can be transferred to hospitals for narcotics, but in the 188 birth centers around the country, that rarely happens, even in the centers where hospitals are just minutes away.
For more information, go to www.birthcenters.org to learn what the standards are for centers set by the American Public Health Association. Learn the detailed requirments for national certification and licensing. Also check out www.lamaze.org to see the six evidence-based care practices for normal birth, and www.childbirthconnection.org to actually read the Milbank report ( at least read the summary), the Listening to Mothers Survey (done by Harris, statistically valid data) and to find many links to start learning more about childbirth.
Finally, many women who do give birth naturally in hospitals, no interventions, no drugs - are shocked to get that $6000 to $8000 hospital bill. That's just nuts for 48 hours with no meds and minimal attention. But that's our system. It needs to change.
Women approach childbirth with ignorance and fear. Education, supportive care (hours and hours of it) and out-of-hospital birth will create better outcomes at lower cost, and best of all, fewer women will have experiences like the first writer.
#7 Apr 6, 2009
Interesting comments. Unlike what you have read into my comments, I am not opposed to choice in childbirth as to where or with whom a woman would like to birth. I am also opposed to mandates. In this case, it would be mandated that women must have nurse midwives. It would also follow the mandate that they have no options for pain meds if they so desire. If that's the way a woman wants to go, great. If not, then what? I had 2 of my 3 kids without meds and the births went fine, the other, well, that wasn't so fine. THere comes a point when every mother should have a right to choose to medicate if that's their wish. THis bill takes away that option.
Better said or do you see my point? They're trying to flip the coin on us.
#8 Apr 6, 2009
With all due respect Bob, there have been a number of shows and books written about America's healthcare system, and they all agree that it needs fixing. Moreover, businesses are not thrilled about paying rising health insurance costs, thereby supporting the fact that the system needs fixing.
We can argue about which party has the best plan to fix it--the Republican plan versus the Democratic plan; however, I would strongly suggest we rethink that. The system has so many problems that it will probably take an independent committee of experts to examine different facets of our health care system, and come back to our nation's leaders with 3-5 proposed solutions. My guess is, health care will not be fixed immediately, but rather in varying stages.
As for the subject at hand, I think births are the least of our health care problems; therefore I agree with the lady, veto this bill and focus on more problematic areas of our health care system.
#9 Apr 6, 2009
The maternity care system is very important in the grand scheme of health care expense. It's a multi billion dollar business.
This bill does not mandate anything, it provides superior service with lower cost options which many women would roll over and thank their lucky stars for.
This is a rare item that is truely bipartisan. I know many republicans and democrats that stand for this because they care about women and babies.
#10 Apr 6, 2009
To Bob & Janet --
Currently, our state pays for 1 out of every 3 births that happen...at an average cost of $13,000 per "uncomplicated" birth. I need statistics on what they pay including ALL unnecessary C-sections, pain meds, interventions such as vacuum, forceps, episotomies.
Ok - here they are:
IF you took all of the MinnesotaCare mothers in HENNEPIN COUNTY alone, and proposed that 20% of those mothers want to choose a hospital birth and want nothing to do with the birth centers, that would leave approx. 620 women birthing out of hospital at an average cost savings of at least $10,000 per birth.($3-4K vs.$13-15K) That is $6.2 million dollars...and over 600 women having experiences that they are in control of, and will cherish forever. Priceless.
Birth IS a significant part of healthcare. Healthy births lead to successful breastfeeding, successful breastfeeding leads to good nutrition, higher IQ, more well-adjusted, healthier individuals. And that's just the babies. Women benefit too.
Any healthcare professional will agree with that. The ripple affect of good birthcare affects ALL healthcare. It's like building a house with a good foundation.
#11 Apr 6, 2009
I loved this fact sheet, especially the "day of the week" stats on cesarean sections.
I took the mean average cost of a c-section $19,000 and subtracted the average cost of an out of hospital birth $3,000 and multiplied it by 1,000 births.
If this bill prevented 1,000 state funded (a random number I selected) unnecessary c-sections in a year within the state it could potentially save the state sixteen million dollars. That's a conservative number of only 83 women per month for the entire state. The problem I'm running into is a number on the actual number of c-sections performed per year in Minnesota. If we had that number we could really crunch the numbers.
The cesarean delivery rate rose again in 2006, to 31.1 percent of all births, a 3 percent increase from 2005 and a new record high. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade.
Saint Paul, MN
#12 Apr 6, 2009
that high for c-sections because there are more people here giving birth then there used to be? Just curious..
I'm done having kids but my kids aren't and what I want for them is good darn care. Period.
Medical care for females in this country has been brutal and dismal at best. Just think, only 30-40 years ago they used acid to eat away at womens breasts if they thought they had breast cancer. Women allowed this brutal treatment because they were scared into thinking they were gonna die...
They still use this scare tactic to do all sorts of horrible 'procedures' on women.
child birth is just the tip of the iceberg. But, childbirth is the first time most women experience these brutal ways of the medical community against women! Like when some docs will literally remove/pull the whole uterus out thru the vaginal to stitch up the cervix. How they are so quick to cut them during childbirth which creates horrible problems for the women afterwards.
if I were younger I would never have children or go to a gyn doc if I knew then what I know now.
older women get the worst treatment because they are "All used up now" according to them. Yep... no need to be gentle or nice to the women over 40... just scare them with cancer fear and they most likely let these brutes do anything to them
it's unbelievable the torture and the money these people are making off of us.
stop the madness.
Saint Paul, MN
#13 Apr 6, 2009
forgot to mention.....
when they did the acid treatments to these women? They were fully aware and awake throughout with absolutely no pain care. They were strapped down/held down and this was done to them.
no.. they did not put them under for these treatments.. too expensive and dangerous to do every couple of weeks!
just like it 'takes too long' to numb someone up before they cut you...so they just cut you.*Happened to my gf's son in the ER, the nurse told her that was why they don't numb it up, takes too long!"
Believe it... they are there for the money. Not much else.
Saint Paul, MN
#14 Apr 6, 2009
Mutilated by brutal 'surgery of last resort'
Collective silence ensured no one was ever made accountable for the butchery of Lourdes. Marie O'Connor reports
Sunday September 07 2008
The Lourdes outrage was in the same class, arguably, as the Bristol child heart surgery deaths. Only the scandal of infected blood exceeds the horror of what became known, wrongly, as the Caesarean hysterectomy scandal.
The focus on Michael Neary has obscured wider issues. Our Lady of Lourdes Hospital shared the ethos of the wider society: conservative, patriarchal and Catholic. Decades of State lethargy gave the nod to medical power, consultant hubris, midwifery subservience and an obstetrical culture that objectified and demeaned women.
The sheer scale of abuse at the Lourdes has yet to be comprehended. Decades of symphysiotomy -- a birth operation permanently widening the pelvis -- paved the way for decades of female organ removal.
Symphysiotomy was often preferred to Caesarean, the norm for obstructed labour: Catholic thinking viewed Caesarean section with suspicion, associating it with sterilisation, contraception and abortion. But symphysiotomy tended to maim women, leaving them incontinent, in pain, and unable to walk properly. Hundreds of these 18th-Century birth operations were done at the Lourdes from the 1940s to the 1980s.
In all, around 500 women had their symphysis pubis filleted, or their reproductive organs removed gratuitously, at the hospital -- not in error, but by design.
How could this have happened? Clinical practice was a matter of personal preference. Some of the unit's birthing practices bordered on medieval. Episiotomy was the norm: even mothers whose bodies had already been stretched by childbirth were routinely cut during the act of giving birth.
Trainees were taught to do vertical incisions, rather than the usual horizontal cuts, for Caesarean section. These incisions left women with long, disfiguring scars down the middle of their abdomens.
Women complained about the fact that doctors carried out medical procedures without their consent. To no avail. In a hospital run by nuns, the culture was one of obedience: showing respect was what was required, not taking responsibility.
From 1974 to 1998, the Caesarean rate rose sevenfold in the Drogheda hospital, from four per cent to 27 per cent. Hysterectomy rates shot up.
Caesarean hysterectomy is surgery of last resort, done to stem uncontrollable bleeding. Obstetricians used to say they might do two or three in a lifetime.
By the 1990s, the Lourdes Caesarean hysterectomy rate was 20 times that averaged by the big Dublin maternity hospitals. The Medical Missionaries of Mary, who were the hospital's owners, seemed oblivious.
A patient complained in 1979, a matron in 1980, a pathologist in 1981. Nothing happened.
But surgery is not a solo run, carried out by a single doctor: it is a team effort. Surgical nurses who handed the hysterectomy clamps to obstetricians , midwives who acted as scrub nurses in theatre, would all have been present. Registrars or senior registrars in obstetrics or anaesthetics, also, at one stage or another. Co
Saint Paul, MN
#15 Apr 6, 2009
But surgery is not a solo run, carried out by a single doctor: it is a team effort. Surgical nurses who handed the hysterectomy clamps to obstetricians , midwives who acted as scrub nurses in theatre, would all have been present. Registrars or senior registrars in obstetrics or anaesthetics, also, at one stage or another. Consultant anaesthetists have a special role in theatre too.
The fact that wombs were being removed routinely was no secret. Staff recorded Caesarean hysterectomies in the postnatal ward daybook, for example. Midwives looked after the injured women post-operatively. Everyone -- the labour ward superintendent, the matron's assistant, the matron -- knew exactly which mothers had had their wombs and/or ovaries removed -- and when.
Consultant pathologists must also have been aware of the phenomenal number of excised organs arriving down to the lab that dissection later found to be healthy.
From 1974 to 1998, the record shows that 188 women had Caesarean hysterectomies at the Lourdes. One obstetrician, Neary, did 129 of these double operations.
We know now that a large number of Neary's operations were carried for complications later found to be unfounded. Also, ovaries were removed arbitrarily -- singly, or in pairs -- in addition to wombs, some during routine gynaecological procedures.
One woman, admitted to the Lourdes for a miscarriage, emerged minus her uterus, as did two others who had simply gone in for a D&C (dilatation and curettage). One mother woke up in the recovery room to find both her ovaries removed; another, who had had a slow third stage (of labour), awoke to find her womb stripped out in addition to her placenta.
Until 1984, the maternity unit published statistics detailing the number of Caesarean hysterectomies performed there annually. Medical bodies asked no questions.
Regulators failed to notice. The Medical Council confined itself to visiting the general hospital, which was in a separate building.
The Royal College of Obstetricians and Gynaecologists visited the hospital twice, lunching at Dr Neary's house, and accrediting the unit for training. The visiting specialists did not reportedly concern themselves with clinical practice, nor did they spot-check the medical records. The non-appearance of the unit's annual report after 1984 went unremarked. Five inspections made by the Nursing Board failed to uncover anything untoward. As did a school of midwifery at the hospital, which was, and is, linked to Trinity College.
General practitioners in the region whose patients were rendered infertile and/or catapulted into premature menopause apparently noticed nothing, either.
#16 Apr 7, 2009
My friend was considering a home birth and my advice to her was this:
Most births are safe. If they weren't, we wouldn't do very well as a species.
Sometimes, complications arise. Think about the high maternal mortality 100 years ago where all births were "natural". Not all complications are predictable. Most are minor and some are bad.
So, you have to decide for yourself and your family what is most important to you.
Chances are, if you have your baby at home (or in a birthing center) all will be well. You will have more control over the experience, you may be more relaxed, etc. And, most of the time, there will be no or only minor complications.
But if you have your baby at home (or in a birthing center) you assume the risk that, if something goes wrong, you will delay access to the medical care that would be available in a hospital. This might result in injury or death of mom and/or baby.
So you have to decide which is more important to you, the experience of birth or the swift access to medical care if something does go wrong.
I would like to be able to make this decision for myself when I have my children and would not like legislation passed that will limit my (or any other woman's) choices in either direction.
Saint Paul, MN
#17 Apr 10, 2009
I think that this is a great idea for an alternative to a hospital. I don't think that this should be a mandate. I work with public health care for the state and I have recently received help also for my second child. My first child was a smooth pregnancy and it was all natural but my second was another story. I needed drugs or it would have come down to a c-section, still should gone that way but the drugs and my dr. helped me through it. Not something that could have happened at a birth center. If I choose a birthing center I could have died because the complications or made the costs higher by needed to be air lifted to a hospital. It should be a choice and yes if truely cheaper encouraged but by no means mandated. I have friends that have had their babies at home with a mid wife it is all about how comfortable a person is with the process. Everyones labor is different and laws can not perdict that. The options need to be open.
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