The Business of Birth

 If you’re pregnant — not sick, why are nearly 99% of women in the US, giving birth in a hospital setting? We have to ask ourselves, despite the United States literally having the second worst newborn death rate in the developed world, why has medicalized childbirth become the default position? Simple answer: It’s the Business of birth.  

After hours of being on the phone, sent from department to department at UCSF, I was finally able to confirm the retail cost of a C-section birth, which is $96,000. A vaginal birth is $68,000. In comparison, I made calls to a plethora of local Licensed midwives in the Bay Area, and for the same service, they charge an average of $5-$8k for a Vaginal birth. A birthing Center, such as SF Birth Center,  will have a facility fee, but even so, the price pales in comparison to the bill of a hospital.

Insurance companies have their top secret contracted rates, and after about two hours of being transferred from department to department, I had yet to receive a clear answer to what this rate is. They told me the only way to find out for sure, would be to essentially to  “have a baby and find out with the bill!”

You don’t go to a restaurant that has no prices on their menu, right?  In that same vein, I don’t want to “order” thousands of dollars of non-emergency health care service without knowing at least a ballpark amount that I will be responsible for!  Insurance companies have agreed contracted rates for any in network provider, yet why don’t they share those rates before the bill is due?

How does it make sense to have a Health Care system where the incentive for the Insurance companies, who are supposed to be there to provide access to care has contradictory incentives to make money off denying your care? Congratulations US, we are the only developed country involving profit-driven insurance companies in our population’s health care!

At a time when the United States is looking for ways to reign in on medical spending, there is a surprising glitch preventing American women from choosing the low-cost option: Many insurance plans do not have midwives in their provider networks, or do not cover midwife care at all.

Our maternal mortality rate has doubled in that past 25 years,  despite the US spending $98 billion a year on the  hospital birth industry. . A third of babies born in the U.S. are delivered by cesarean section, and researchers estimate that about half of those surgeries are medically unnecessary. Some doctors are apparently inducing labor and performing C-sections on request for patient preference or so-called “designer births”.

Insurance companies are largely to blame, as many obstetricians aren’t even allowed – or trained – to perform procedures most midwives are qualified to handle, intervention-free. Delivering breech babies, for example, ends up turning surgical far more frequently than it needs to resulting in more complications, and more deaths.

Birthing Centers and home births are statistically proven to be safe, with low rates of interventions and without an increase in adverse outcomes for mothers and babies, as studied in the peer-reviewed Journal of Midwifery & Women’s Health. This also results in a remarkably lower cesarean rate of 5.2%, compared to the  U.S. national hospital average of 31%.

No doctor wants to be on that witness stand explaining why he didn’t do an ultrasound or use a fetal monitor. Malpractice insurance is so exorbitant that it has led a lot of doctors to stop doing obstetrics all together. The result is that currently in hospitals, you aren’t allowed to ambulate (deliver squatting rather than supine) and interventions like epidurals are commonplace and fetal monitoring is required at the expense of impeding a healthy mother to allow her body to react and move the way it is called to move.

Still, a cultural shift is underway. Thanks to the popularity of documentaries like The Business Of Being Born, as well as alternative birthing services such as SF Birth Center, the truth and traumatic experiences we are learning from are changing minds, beliefs, and behavior around birth.

Most people don’t know that they can get their insurance company to cover Birth Centers or in-home births with Certified Nurse Midwives, if you insist and ask about their policy. The most important thing is to make sure you get the “allowed rates” of what your insurance will cover beforehand so you won’t be left fighting a bill. Something so life-altering and important should not be dictated based on business, but on your terms.