It cost HOW MUCH??

Most of the birth blogs I read have talked about one or both of the birth-related articles that recently appeared in the LA Times and Time magazine. But Knitted in the Womb talked about one I hadn’t seen — from the Wall Street Journal, which talked about the hospital bill a woman received for her uncomplicated vaginal birth: $36,625! Although the total cost was negotiated down by the insurance company (about half off), she still had to pay a percentage of the bill, and had the nasty surprise of finding out that in addition to her annual deductible, her newborn had his own deductible to meet! [If you haven’t read the other articles, Knitted in the Womb has the links on her blog page.]

Not having had a hospital birth, it was definitely a curiosity to me to see certain aspects of this as-yet-unseen type of bill. It was a rude shock, but important for everyone to know, because even if you believe you don’t pay out of pocket, you really do, because all costs the insurance company incurs are passed along to their customers in one form or another. You’re paying for your coworker’s C-section. Fun, huh? [Oh, and don’t expect nationalized health care to improve matters — it will have all the (in)efficiency of Medicare and Medicaid, but on steroids.]

Back to the article — she writes that she requested an itemized statement to make sure she wasn’t billed for services she did not actually receive, and found that the sterile epidural tray cost $530.29.  Then writes,

An “Anes-cat 1-basic Outlying Area” was billed at $2,152.55. (I was told this was the cost of the hospital’s resources related to the epidural.) These items were in addition to the separate anesthesiologist’s charge of $1,530 for giving the epidural. Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high. [In case you haven’t added that up, it’s over $4,000 for an epidural. And people think that childbirth classes and a doula, which can help you avoid needing an epidural, are expensive! The woman had to pay 15% of charges, so if these charges were the final charges her insurance company agreed to, then that’s about $630, which could cover both childbirth classes and a doula in many areas of the country.]

… the hospital listed a price of $2,382.92 for my recovery, when I hadn’t had a Caesarean section. It turned out the charge was for the 90 minutes I spent in the birthing room after my delivery. I recalled lying exhausted there while a kind nurse checked my vitals and cleaned me up. Important help, for sure, but was it really worth that much money? [This cost of recovery is nearly as much as I paid for my whole birth “package” with my midwives each pregnancy. The prenatal visits were anywhere from 30-90 minutes long, plus they came to my house for the birth and stayed during labor and for a few hours afterwards checking on me and making sure everything was cleaned up. Oh, and it included a labor doula, too!]

Interesting, to be sure. To those of you who have had hospital births, did you know these charges (or anything like it) beforehand? If you have insurance, did you ever see these kinds of bills, or only your out-of-pocket costs (whether home or hospital birth)? If you work in a hospital, are you aware of how much people are billed for services in your hospital, or is that “just something people in billing deal with”?

“Birth Matters Virginia” Video Contest

Previously, I had blogged about the video contest sponsored by Birth Matters Virginia. Now that the deadline for new entries has passed, there are 44 videos in the running. In order to be considered for the contest, entries had to have a YouTube tag of “BirthMattersVirginia,” so it’s easy to find them. Here is the link to all the videos with that tag. I haven’t had a chance to watch them yet, but it promises to be good. Remember to vote for your favorite(s)!

Here is a video that was included in the facebook group’s links, but is not actually entered in the contest (perhaps because Dr. Buckley is one of the judges, and also appears in the video?). Enjoy “We Can Be Much Kinder,” a video about delayed cord clamping:

Educated Birth

This is a video which was made for the Birth Matters Virginia Contest. It’s not my video, but I liked it. (I’m sure there are many other videos made for this contest, so you can probably do a YouTube tag search and find them. If I have time, I’ll try to remember to do this myself.) Because it’s in the contest, please make sure to rate it!

Thanks to Diana for the link!

K’s birth story

Today is my oldest niece’s birthday, and the first grandchild of our family, so I thought I’d give her birth story (from my perspective).

My sister had planned a natural birth — that is, she intended on giving birth without any drugs. She did not take any childbirth classes, read few if any books, didn’t ask about her hospital’s policies or procedures, just assumed that since billions of women for thousands of years have been giving birth without the aid of narcotics, that she’d be able to do it too.

When my sister went into labor, there was a lot of snow on the ground — for us in Mississippi, anyway! We were actually able to build a snowman about as tall as we were, which has happened maybe two or three other times in my life (the other few occasions we had a lot of snow, it didn’t pack together well). So, when it became obvious that the contractions were regular and not going away, my sister and her husband headed to the hospital. There was none of this, “stay at home as long as possible” because not only was there snow on the ground, but also the hospital of their choice was about 90 minutes away in good condition. They wanted to leave in plenty of time because they weren’t sure if the roads were going to be treacherous with the snow, and wanted to make sure they didn’t have to drive fast and end up in a wreck, or hit an icy patch and spin out. (The roads were actually fine, once you got on the highway.) When she got to the hospital, they wouldn’t admit her because she wasn’t 4 cm dilated yet, so she went to her in-laws’ house to wait. And wait. Eventually, she dilated enough, so they admitted her.

Once she was admitted, she was made to be on continuous monitoring (although I don’t think there was a medical reason for it — she hadn’t been given any pain medication, and I don’t think she was given Pitocin until much later). At one point, she had to use the bathroom, but they wouldn’t take the monitor off. Nor did they bring her a bed-pan. Finally, she unstrapped herself and relieved herself, and the nurse came in and chided her for taking off the monitors and getting out of bed, because it meant that she (the nurse) had to leave the nurse’s station and come into my sister’s room to put the straps back on.

Details are a little fuzzy at this point. I know she finally got some Stadol to help with the pain, and she slept for a few hours. Her labor was over 24 hours (but I don’t remember if that included the time before they left for the hospital when she was in early labor, or just the “active” phase), much of that time was spent flat on her back. The baby was born face-up, which means that she was posterior during labor as well, meaning my sister had to deal with back labor much of that time — and perhaps all of that time. Had she been allowed to move during labor, her labor probably would have progressed faster and more smoothly, and the baby would have rotated into a better position. Instead, she followed orders and stayed in bed. Finally she got an epidural, which she said was wonderful. Her experience was so bad that she jokes that when she went into the hospital to give birth the second time, she walked in backwards, so that she could get the epidural that much faster. She pushed for four hours, and my niece was born with the worst cone-head I’ve ever seen. I guess the “good news” is that she avoided a C-section.

During labor, I might have gone into her room once; maybe twice. Our whole family was excited — first grandchild and everything — and they hadn’t found out the baby’s sex by ultrasound, so there was still the anticipation of finding out if the baby was a boy or a girl. We camped out in the waiting area. My mom was obnoxious to get in my sister’s room. I found out much later that my sister had told the nurse to keep my mom out because she didn’t want her in there. I can’t really blame her — my mom is such a “nervous Nellie” when it comes to things like this that had she been there, it probably would have gotten my sister nervous and perhaps made her labor take even longer.

Still, after the baby was born and we all went back into the room, my mom had a legitimate reason to complain. My sister’s mother-in-law — actually her husband’s stepmother, so no blood relation at all — got to the baby first and held her before my mom did. Of course my mom didn’t say anything, but she didn’t like it.

Main lesson I learned from this: if you plan a natural birth in the hospital, you must put forth some effort and do some homework if you actually wish to succeed. My sister might have been able to accomplish giving birth without pain medication under the circumstances related above just be sheer grit and determination; but it wouldn’t have been a pleasant experience, and probably not an empowering one. Had she done some reading and learning beforehand, she would probably have had enough strength to ignore the nurses’ commands to stay in bed, and instead would have labored in a way that was more comfortable to her. But, she was a “good little girl,” and followed orders. Consequently, she had a horrible birth experience, which ultimately was unnecessary.

What you can do…

Previously, I blogged about the lawsuit brought by Catherine Skol against the doctor who attended her birth, alleging that he mistreated her in a variety of ways. But while I think this story deserves to be told, and women especially need to understand that this sort of treatment might possibly happen (although I believe and strongly hope that it would be rare and therefore not likely to happen to them), my larger concern is keeping it from happening. As I was reading the allegations in the lawsuit, I was picturing what the scene may have looked like, and I began wondering what she or someone else might have done to stop her “care” provider from treating her like that.

One homebirth midwife’s blog I read recently talked about birth plans, and she encouraged women not to put things in their plans that they can control, such as requesting that they be allowed to wear their own clothes instead of hospital gowns, or requesting that vaginal exams be kept to a minimum. This midwife said, “Want to wear your own clothes? Just keep ’em on! Don’t want a vaginal exam? Keep your legs closed!” And that’s true. But it’s easy to say and many times hard to follow through with. I can’t tell you how many stories I’ve read of doulas (either professional or just friends attending another friend’s birth) who reported that, in the period leading up to labor, the woman was most adamant about having X, Y, or Z, while refusing A, B, and C, and that she wouldn’t cave to pressure, no matter how much — “it is gonna be my way or the highway” kind of talk. And then the doula gets the call that the woman thinks she just started labor and is going to the hospital (when she had previously said she would stay at home as long as possible), and by the time the doula got to the hospital, the woman was in bed with continuous monitoring, an IV in her arm and an epidural in her back — all of which she had in no uncertain terms said she would not have.

And that’s fine — it’s her choice, and she can change her mind all she wants. But it’s one thing to change your mind, and another to have it forcibly changed for you. And speaking from my own experience, in labor, I became very willing to do whatever anyone suggested. It may have been because I trusted my midwife and felt so comfortable with what she was telling me; or I might have just as easily followed anybody else. For me, it keeps me “on the strait and narrow” when it comes to selecting my birth attendant(s), to make sure that whoever I get will be comfortable with my wishes and protect my birth plan and desires and wishes unless these plans truly need to change.

Catherine Skol, the woman who brought the lawsuit, did have a doctor she trusted, but he was on vacation when she went into labor. The doctor named in the lawsuit was his back-up. This situation (the possibility of having an unknown doctor or perhaps somebody you know you don’t like) has led many women to choosing an unnecessary induction or even a C-section with the doctor of their choice than to take a gamble on someone else. Other women have chosen a very small practice (even one or two midwives or doctors), so that they can know both or all of the people who may possibly be in attendance at their birth. But it could be that even the best-laid plans go awry, and you may end up with somebody you don’t know at all. Hopefully, they will be just as nice and respectful as your chosen birth attendant, but what if he or she is not? What can you do?

I read several different L&D nurses’ blogs, so I left a comment about this case, and asked them what someone could do if they are faced with such a situation (hopefully never as bad!). Obviously, one thing a woman could technically do if, as in the case of Mrs. Skol, she was placed in stirrups in a painful position and/or told to push before being fully dilated, is just simply not to comply. But, again, it’s easier said than done — especially when the doctor is being verbally aggressive, telling you things like “shut up and push”, repeatedly saying that you will hemorrhage, and implying that your baby is going to die (and she had had a stillbirth years before, so that especially scared her). Her husband might have been an advocate for her — except he may have been as cowed by the doctor as the woman was; or he may just not have realized how awful the treatment was.

Here is a link to one of the nurses’ blogs I mentioned. She responds in some length to the questions I asked, so rather than try to summarize, I’ll just let you go over and read the full thing yourself.

Another blogger said this, “You can bet I would have been getting my charge nurse, nursing supervisor, and the head of OB involved if I faced this type of situation. I certainly would not have kow-towed to the OB and his arrogant, rude, abusive behavior.” [The idea of pulling my foot out of the stirrups — if I even let myself be put in that situation in the first place — and kicking the doctor in the face occurred to me, too.]

A lot of the things you can do are also going to be just your general “educate yourself” (and educate those who you will be bringing with you) and “stand up for yourself” (or have your labor support people stand up for you). I assume that since none of the nurses and the other doctor in the room were co-defendants with this Dr. Pierce, that Mrs. Skol did not find that they contributed to her maltreatment in any way, and were perhaps even trying to stand up for her. You have the right to ask for a new doctor and/or a new nurse. Unfortunately, the way some hospitals are set up, you may just not be able to get a change, or it might not happen in time for the birth. Large hospitals may have more than one doctor on the premises at all times, and a switch can perhaps take place almost immediately; smaller hospitals may have no doctors on the premises except to attend the actual birth, and may have to wake up another doctor and beg him to come in before you can have a different doctor. Obviously, there will be more than one nurse in the hospital, but some of the blogs I’ve been reading lately have been full of the more technical aspects of L&D nursing life — how women are assigned to which nurses, what their jobs are while the women are in labor or giving birth, how many nurses are in attendance during a C-section, etc., and it may be that if you ask for a change of nurse that it might take some time — simply because all the nurses on the floor already have their hands full, and it’s not just as simple as walking from one room to another to switch nurses. (Lovely paperwork!) But it certainly won’t hurt to ask.

If you have the opportunity to take a non-hospital-based childbirth education course, do it! You will learn what “normal” is and will probably get tools on how to advocate for yourself. This sort of treatment shouldn’t happen to anyone, but if you know what is normal and what is bad behavior, and if you know what to ask for and how to ask, you will reduce your chances of this sort of thing happening to you. Talk to your midwife or doctor, as well as the hospital staff before you go into labor, to try to know as well as possible what you can expect when you go to the hospital to give birth. Find out what they are inflexible on; find out what they would like but won’t insist upon. If you don’t like what you hear, the earlier you decide your course of action, the better. You can change hospitals and/or doctors, or even switch to a birth center or home birth; but many people are unwilling to take on new clients who are already at or very near term. You can also change your preferences (“I’d really rather wear my own clothes, but, y’know what, I’d just rather not fight it”). Knowing what is likely to happen will probably make you more comfortable as you head into labor — at least, I’m extremely uncomfortable when facing new situations, and always prefer to find out as much as possible beforehand. Also, if your hospital says that their protocol requires you to have or do X, Y, or Z, you may be able to get out of that by having your doctor write in your birth plan that he is authorizing a change of protocol for you.

Still wondering what to get for Christmas?

If you’re like me, you may have to buy yourself your own Christmas presents. If you’re like most women, even if you don’t have to buy your own presents, you’ll have to buy Christmas presents for everybody else in your life (and your husband’s life) too. “What to get for Christmas” — either for yourself or others in your life — is always a difficult question to answer. Laura Keegan has made it easier. I know I just blogged about her book Breastfeeding with Comfort and Joy, but I want to do it again, because I didn’t realize when I wrote my earlier post that there were excerpts from the book available on her website — just click on the picture of the front cover to view 9 pages from the book.

This book is self-published, and is available only from her website. Since she has to do all of the promoting and distributing herself (not having a big publishing house to undertake the marketing), even if you cannot purchase a copy of the book right now, she would sincerely appreciate any help you can give in “spreading the word”, by telling people about her website (The Breastfeeding Book.com), on your blog, or any birth, baby, or “natural living” or “alternative” email lists or groups you’re a member of, or even the old-fashioned way of talking one-on-one.

Some of the people I thought of who would be interested in the book include the following:

  • midwives
  • doulas
  • childbirth instructors
  • obstetricians
  • La Leche League groups or leaders
  • breastfeeding consultants
  • lactation specialists
  • WIC offices (since they serve low-income mothers and babies, who are at higher risk of many negative occurrences, these women and children can especially profit from the benefits of breastfeeding)
  • pediatricians
  • L&D nurses
  • nurses or other workers in hospitals or doctors’ offices
  • family physicians
  • any “birth junkie”
  • pregnant women
  • new moms (and this is not limited to first-time mothers — I just recently found out that one of the people on an email list I’m on has for the first time managed to successfully breastfeed her child beyond 2-3 weeks… and this is baby #5! Nursing was excruciating for her with all of the babies, and she always gave up; finally she decided to stick with it, even through the intense pain, for at least 6 weeks. Getting past the three-week mark finally made breastfeeding not (as) painful for her, and she can actually see herself continuing to nurse her baby.)

If you want to give a meaningful gift to any of the above people in your life — whether for Christmas, a baby shower, a “thank you” gift, a birthday present, Mother’s Day, or “just because” — this will be truly appreciated. Even if you can’t get this book in time to present it at Christmas, you can order the book, and give a beautiful card telling the recipient that the present will be arriving very soon. Also, when you get those, um, less-than-wonderful gifts on Thursday, and you’re tempted to exchange it at the store — why not get a refund, and then buy yourself what you really want? And why get just one book? — order several, so that you’ll always have something to give when those gift-giving occasions sneak up on you or slip your mind.

I can’t wait to get mine!

Why plan?

One of the things that is often discussed is whether or not a woman should make a birth plan. There are a few different schools of thought on this. One is, “Women don’t need any plan other than, ‘Go to hospital; have baby.'” Another is, “Birth can’t be planned, so you shouldn’t even try.” Another might be, “You can plan if you want to, but it won’t turn out that way so you’re wasting your time.” There are also some more positive constructions, obviously.

Some people are consummate planners — they have the Day Planner in which they put everything, and are super-organized, and know how they’re going to spend every minute of every day for the next year. They may even be called “obsessed.” Others are the polar opposite — even trying to figure out what to eat for supper that evening, or what to wear the next day to school or work is too restrictive on their “freedom.” Most people are in the middle.

Apparently, my father-in-law was (and still is) very much a planner when it came to family vacations. He would literally have the whole time planned — they would leave home by such-and-such time, and drive so far, eat in this town, drive some more, get to the destination by suppertime, eat, and go to bed. And every day of the vacation was similarly planned. Spontaneity was not smiled upon. There may be some slight variations allowed (You want to play ping-pong instead of foosball? Okay), but in general, he had his plan and it was followed.

When I got married, I paid a lot of attention to a lot of little details about the wedding. I planned a lot of things, obviously — you have to do that when you’re organizing a medium-sized church wedding. If you want to stop in at the Courthouse, not so much needs to be planned; but if you’re going to have a couple of hundred people in attendance (and to feed!), you’ll want to be prepared. For all of you who have ever planned anything, whether a vacation or a wedding, or anything that you thought of more than week in advance, I ask you, “Why plan?”

Are the same thoughts screeching through your head that are screeching through mine? “What?? ‘Why plan’?!? Is this person an idiot? Of course these things have to be planned!! I have to know how much food to buy, or clothes to pack, or money to take… I’ll have to take off work or get somebody to watch the kids or….

What if I said, “Well, you can plan, but you know it’s not going to work out the way you plan, so you’re just wasting your time!”? After all, nobody who gets married plans on having the groom pass out, or the flower girl showing off her pretty panties, or the ring bearer picking his nose, or the flowers getting lost, or the cake getting crushed — but all these things happen in weddings every day. Nobody who goes on vacation plans on having a car wreck, or the alternator going out in the middle of nowhere, or getting a stomach bug the whole week, or having the luggage get put on the wrong plane, or finding out the hotel has lost your reservation — but all these things happen, too.

The fact is, there are things that happen that are not planned, but that doesn’t mean that having a plan to start with is a stupid idea. In fact, it’s usually stupid not to plan. The inspiration for this post came from reading this article, “Homework is the Mother of Prevention,” which I first saw on The True Face of Birth.

This Australian author begins by saying that she was not known to “be prepared,” and in fact ended up quite sick when she went to Latin America, completely unprepared because she refused to read any of the travel literature.

But when I was pregnant I managed to break the bad habits of a lifetime. My motivation was hearing about the many apparently normal, healthy pregnancies that spiralled out of control in the labour ward, ending in unplanned and invasive medical interventions. I was told that labour is just like that — unpredictable, chaotic, terrifying. A bit like my Latin American adventure. But while friends and family didn’t hesitate to censure me for my haphazard approach to overseas travel, the opposite was true of my careful preparations for labour. If I had a dollar for every time I was told that birth plans were futile, since things would never come out the way I expected, I could almost have doubled my baby bonus.

I strongly urge you to go read the full article, because it has many salient points. But just to sum up what I’ve already said — just because life is ultimately unpredictable, that doesn’t mean you shouldn’t plan.

Pregnant women already attract unjustified scrutiny and criticism. No woman should ever be judged for the decisions she makes while in labour, given how indescribable and unexpected that experience really is. But how a woman handles her preparation is another matter entirely, and maybe a lack of preparation deserves scrutiny. To just “wait and see” when the stakes are so high is simply negligent — both for the mother’s health and for her baby.