Thursday, June 21, 2007

More from the VBAC vortex

A story from in which I was quoted about the controversy surrounding VBAC.

Tuesday, June 19, 2007

More Fundus

At a midwifery conference over the weekend I did a reading of my book and a talk about how midwives are portrayed by the mainstream media. (The short answer is not well.) For proof, see the below post in which I was quoted about the cost of giving birth. The first paragraph, however, is gratuitously disparaging to midwives, who attended most births in the early 20th century. Anyway, the midwives I spoke with at the conference still love their work and maintain their sense of humor, despite the crazy hours, occasionally unreasonable mothers and mediocre pay. A bumper sticker on one of their cars read: Midwives have more fundus. Indeed.

The cost of giving birth

This was an interesting story off a new report on the cost of giving birth in a hospital. The story does not, however, compare the bill with charges for home birth or those in a birth center (both much cheaper.)

The average cost of an American birth: $8,800
By Barbara Feder Ostrov
Mercury News
San Jose Mercury News
Article Launched:06/12/2007 06:30:00 AM PDT

At the turn of the 20th century, having a baby was dangerous, but not all that expensive: Women simply hired a midwife for a couple of dollars and prayed they wouldn't die on the kitchen table.
Today, the average cost of giving birth is about $8,800 higher, according to a new study released today by the March of Dimes.

Nationally, a vaginal delivery cost $7,737, with C-sections averaging about $11,000.

Giving birth costs the most in the Northeast, mostly because of the higher cost of living. Western states are the next most expensive; it's cheapest to give birth in the South.

Researchers examined insurance claims in 2004 for more than 43,000 deliveries, including prenatal care, delivery and newborn health care for three months after birth. The women studied had traditional employer-provided health insurance rather than HMO insurance and were not covered by government programs such as Medi-Cal.

It's important to study childbirth costs because pregnancy and childbirth account for nearly a quarter of all hospitalizations in the United States, the researchers say, with families, insurers and government sharing the costs.

The researchers found that insurers covered most of the cost of childbirth, with the women paying an average of $463 out-of-pocket for vaginal deliveries and slightly more for C-sections. Many consumers, however, report that their out-of-pocket costs are higher, depending on the care they receive and type of insurance they have.

When Colette Niazmand, a 30-year-old marketing manager from San Jose, planned for her child's birth, she estimated that she would pay about $5,000 to $10,000 out-of-pocket if she used the preferred provider plan offered by her employer. Instead, she chose to be covered under her schoolteacher husband's generous HMO, which essentially covered all prenatal care and childbirth costs.

"We were very lucky," said Niazmand, whose daughter is now 3-months-old. "We were prepared to have to pay some portion of it."

The study's findings point to the need for affordable health insurance for families contemplating having a child, said Dr. Jennifer Howse, president of the March of Dimes.

"Having a baby is the most costly health event families are likely to experience during their childbearing years," she said. "An uninsured healthy pregnancy can be a financial strain on young families, and a catastrophe in the case of a high-risk birth."

The costs can spiral even further if a baby is born prematurely: In another study conducted using data from 2001, the researchers found that a year's worth of health care for a premature baby averages $41,610, compared with $2,830 for a healthy, full-term infant.

In a related study conducted by the Kaiser Family Foundation and also released today, researchers found that women with so-called consumer-driven health plans faced much higher out-of-pocket costs than women with more traditional forms of health insurance. Consumer-driven health plans typically offer lower monthly premiums but higher deductibles, and some of these plans offer skimpy maternity coverage.

Childbirth costs also are financed in part by taxpayers: Medicaid (called Medi-Cal in California) finances about 40 percent of deliveries in the United States, according to the study. At Santa Clara County's safety-net hospital, Valley Medical Center, about 95 percent of the nearly 6,000 babies born each year are covered by Medi-Cal, said hospital spokeswoman Joy Alexiou.

Costs for all kinds of health care, including childbirth, have skyrocketed in the past few decades, in part because of improved medical technology and medication.

Women in the early part of the 20th century typically delivered at home, with hospital births becoming routine only with the rise of health insurance after World War II, said Tina Cassidy, author of "Birth: The Surprising History of How We Are Born."

Today, childbirth often takes place in hospital birthing suites with sophisticated infant and mother biomonitoring, attended by obstetricians, nurses and anesthesiologists.

And if the cost of childbirth doesn't make you blanch, consider the current price tag for raising a little bundle of joy until age 17: $197,700 for food, shelter and other necessities, according to the U.S. Department of Agriculture.


More information on both studies is available at For government assistance with childbirth costs, low-income or uninsured Santa Clara County residents can call Valley Connection at (888) 334-1000.