Wednesday, January 13, 2010

Obamacare and Maternity Health: What's Missing...

...from this article?

Perhaps the biggest loss for women's health reform is that with all the drama over abortion, maternity care has remained a huge blindspot — and a costly one, at that.

The US spent $86 billion on maternity care in 2006 and another $26 billion caring for babies born preterm, now also at a record high of 12 percent. Prematurity is a leading cause of infant death, yet the majority of premies are induced or surgically delivered too early. This over-medicalisation means that childbirth costs Americans more than twice per capita what other countries with better outcomes spend. Medicaid picks up nearly half the bill in the US. If we gave just a little attention to improving care, we could literally save billions.

"Improve quality and reduce costs" — this has been Obama's mantra for health reform. How is it that instead of addressing real threats to women's and babies' health, "reform" has led us toward rolling back abortion access? Advocacy groups have been defending "abortion rights" and, to a lesser extent, "birthing rights," but it's possible that such a single-issue focus has helped to marginalise. To what other bodily system or medical procedure do we attribute rights? We don't have endocrine rights or MRI rights; men don't have testicular rights or Viagra rights. Rights belong to human beings. We have rights.

Or do we? A society that would force a woman to carry an unwanted pregnancy would also force her to have major abdominal surgery. Women won't get real health reform until we reform this fundamental lack of respect for women. The bus stops here.

The author, an abortion supporter, notes that women's health care is about far more than abortion, even though that one procedure sucks all the oxygen out of any conversation. She then goes on to discuss the difficulty many women face trying to have a Vaginal Birth After Cesarean (VBAC).
The Vbac ban is only a subset of a much larger problem. Decades of research tell us that optimal maternity care is something very different from what most American women receive. Optimal care means that the physiological birth process is supported with minimal intervention: labour begins spontaneously, women are free to move around and push in upright positions, and providers avoid surgical intervention unless absolutely necessary.

Meanwhile, the majority of labouring women are confined to hospital beds, strapped to mandatory but ineffective fetal monitors, induced or sped up with artificial hormones, and consequently experiencing unnecessary pelvic trauma and the highest cesarean section rate on record, at 32 percent (10-15 percent is considered the maximum we would expect for health reasons). If you question whether this has anything to do with women's bodily integrity, talk to a woman who's had an infected caesarian scar or an episiotomy that tore into her perineum.

But why do women face so many roadblocks to birth the way they want? The author doesn't address it, but the answer is simple: money and liability. Sites like this one help the prospective plaintiff look for a John Edwards-style ambulance chaser to help them get their jackpot justice. This forces doctors, hospitals and insurers to go to greater lengths to thwart lawsuits. That means forcing women to have cesareans rather than allowing them to determine the risks and rewards of vaginal births, pain medication, fetal monitors and so on.

Those really concerned about protecting women's bodily autonomy should include tort reform in any health care bills. I don't expect that to happen in the Democrats' Obamacare debates.