Preventing First Cesareans- Consumer Statement

Many expectant parents are concerned about the high rate of cesareans. Indeed, they have reason for concern. One in three women in the United States (32.8%) now give birth by cesarean, and the dramatic rise in the cesarean rate has not improved outcomes for women or babies.  The World Health Organization recommends a cesarean rate between 5 and 15 percent, because data suggest that rates above 15 percent may do more harm than good. Cesareans can be lifesaving when they are needed, but when they are used without a medical reason, the risks can outweigh the benefits.

In order to bring down the rising cesarean rate in the U.S., the American College of Obstetricians and Gynecologists (AGOG) and the Society for Maternal-Fetal Medicine (SMFM) released guidelines for the “Safe Prevention of the Primary Cesarean” in February 2014. These groundbreaking guidelines recommend changing many standard elements of maternity care and have the potential to dramatically improve the quality and experience of maternity care for the women of New York City and across the United States. CiC has created a summary, available for free download, of some of the key recommendations made by ACOG and SMFM so that you can discuss them with your doctor or midwife.

Ask how your doctor or midwife and your hospital or birth center are responding to these new recommendations

Preventing First Cesareans- Consumer Statement

New Research: Doula Support Reduces Odds of Cesarean Section by 40%

A new study entitled “Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries” was released online last week in the American Journal of Public Health and is creating quite a stir within the childbirth community nationwide.  Paired with National Birth Center Study II, released last month by the Journal of Midwifery and Women’s Health,  it seems that the movement toward more choices in maternity care is gaining strength.  The National Birth Center Study provided evidence for increased access to midwifery care and birth centers by showing that women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean births compared to women who give birth at hospitals.

The new study on doula care compared childbirth outcomes of women insured by Medicaid who received doula support to those who did not.  Researchers at the University of Minnesota School of Public Health found that doula support reduced a woman’s odds of giving birth via Cesarean section by more than 40%.  They also found a decrease in preterm births of almost 20% in the doula supported group.

Past research has shown that doula support results in other positive birth outcomes, such as:

• Increased initiation and duration of breastfeeding
• Shorter labors
• Less need for anesthesia or analgesia
• Fewer vacuum and/or forceps births
• Higher APGAR scores
• Better mother-baby bonding
• Less postpartum depression

The study goes on to discuss the possible cost savings to Medicaid programs if they were to provide reimbursement for doula services, since Cesarean sections are approximately 50% more expensive than vaginal births.  The researchers are hesitant to provide concrete numbers because costs and associated benefits would vary widely by state.

But since blogs aren’t held to the same high standards that research articles are, we decided to come up with a very approximate estimate, just for curiosity’s sake.

Number of births in US per year	Estimated Percent of US births covered by Medicaid	Estimated Number of US births covered by Medicaid	US Cesarean section rate (2010)	Estimated number of Medicaid-covered Cesarean sections in US	Percent of Cesarean sections prevented with doula support	Number of cesarean sections preventable through doula utilization	Difference in cost between Cesarean section and vaginal birth	Resulting savings to Medicaid programs per year
3,999,386	46%	1,839,718	32.8%	603,428	40.9%	246,802	$4,500	$1.1B

This very rough sketch of the money that Medicaid programs would save if every mother had access to doula support doesn’t take into account the considerable cost of providing that support.  If Medicaid reimbursed for doula care at $500, and offered support to every mom, the cost would be about $920M.  That would still yield a net savings, after reimbursement, of nearly $200M.  Not to mention all those better outcomes for mom and baby.

This seems (to us) to be one of those wonderfully poised, win-win initiatives that leads to both happier, healthier moms and babies and cost savings for a taxpayer-funded program.  What would happen if there was a campaign in every state to bring this issue to the forefront and get doulas for all women?  And are you willing to help?

Watch CiC’s Executive Director, Elan McAllister, discussing doula care on Huffington Post LIVE

Article Citation:

Backes Kozhimannil, K., Hardeman, R., Attanasio, L., Blauer-Peterson, C., & O’Brien, M.  (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries. American Journal of Public Health. e-View Ahead of Print.  doi: 10.2105/AJPH.2012.301201

Bearing the Burden of Choice: A Young Feminist’s Perspective

By Meagan Fuller, guest blogger

Group of Feminist Campers Winter 2013, photo credit: Carly Romeo of Two Spoons Photography

I came to NYC to participate in the ultimate feminist vacation, conference, and networking event, Soapbox, Inc.’s Feminist Camp. A week packed with visits to social justice organizations from foundations to grassroots activist groups, Feminist Boot Camp was an opportunity for aspiring social justice advocates to discover modern activism and what feminism can look like in professional practice. One of our stops was at Choices in Childbirth.

Here are some notions with which I walked into Choices in Childbirth’s office:

Based on personal observation, choices concerning women’s reproductive health are heavily concentrated in preventative action – what are the best practices to avoid pregnancy?  Consequently, prevention inspired language lends to a negative association with child bearing. It is something to prevent rather than embrace.

Language surrounding abortion lends to the same effect. Public health initiatives emphasize preventing pregnancy through the use of contraception, but when spontaneity clouds the campaigns and the unplanned happens, how does one tackle the heaviest choice of all?

Throughout the week long journey, the controversial plight of feminism, the legal right to have an abortion, was a reoccurring topic. Abortion is one of those issues that seems to leak into every “women’s issue” whether initially intended or not. Needless to say, we talked about abortion to the point of exhaustion. Not to take away from the weight of abortion to the feminist cause, I began to recognize a gap in our reproductive justice discussions. I found myself asking the question:

What about the women who choose the path of childbearing?

Following an intense viewing of the documentary entitled, The Business of Being Born: Classroom Edition, filled with intervals of happiness, anger, laughter, and even tears, I, along with my fellow feminists, learned how choices in the realm of prenatal, postpartum, and maternity care have been institutionalized. Who would have thought the phrase “turnover rate” would be used in the context of maternity care? The interviews from the film resonated throughout subsequent meetings, bringing to light to what extent choice is a heavy word, heavy in the sense that it comes with great responsibility and repercussion, but also, limitation. Choices are saved for the privileged, ostracizing populations of women who do not have access to the resources which would allow them to make individual decisions about their pregnancy. As social justice advocates, feminists like me seek to challenge the essence of privilege that dictates the amount of choices one has. Feminists are the defenders of choices in reproductive health, extending this privilege to every person, regardless of their demographics. Perusing pamphlets listing countless resources and venues through which women can access their preferred maternity care, I found my prior questions answered in the humble work of Choices in Childbirth.