Insurance Companies Rejecting Women with History of Cesarean

Some Companies Require Surgical Sterilization for Coverage;
Trend Gives New Imperative to Learn Ways to Avoid Unnecessary Cesarean

Redondo Beach, CA, June 1, 2008 – As reported in today's New York
Times, ICAN has begun tracking an alarming new trend of insurance
companies refusing to provide health insurance for women with a history
of cesarean surgery. In some cases, women are being rejected for
coverage outright and in other case they are being charged significantly
higher rates to obtain the same coverage as women without a history of
cesarean. With over a million women each year undergoing this surgery,
this practice has the potential to render large numbers of women
uninsurable.

This trend surfaces as the rate of cesarean surgery, including
unnecessary cesareans, continues to rise. In 1970, the cesarean rate was
5%. In 2007, it was 30.1%. Experts often cite the incentives within the
health care system for driving up the rate of cesarean unnecessarily,
including physicians' medical malpractice fears, better reimbursement
for surgery, and lifestyle conveniences for care providers and staffing
efficiencies in having more "9-5" deliveries.

"Women are caught in the middle of a dysfunctional system. Doctors are
telling them they need surgery, even when they don't, and insurance
companies, who are tired of paying the bill for so many frivolous
surgeries, are punishing women for the poor medical care of doctors,"
said Pam Udy, President of the International Cesarean Awareness Network
(ICAN).

The trend is highlighted in the cases of women like Peggy Robertson of
Colorado. When she applied for health insurance coverage with Golden
Rule, her husband and her children were accepted, but her application
was denied. After multiple inquiries directed to the insurance company,
she was finally told that she was denied because she had delivered one
of her children by cesarean. "It was shocking. I assumed that as a woman
in good health I would be readily accepted," said Robertson. "When I
finally found someone who would explain why my application was denied,
they had the audacity to ask me if I had been sterilized, stating that
this was the only way I could get insurance coverage with them."

As the incidence of cesarean increases, the evidence of the downstream
medical complications for women and babies, and the associated medical
costs, becomes increasingly apparent. Risks of cesarean in later
pregnancies include increased incidence of infertility, miscarriage,
fetal deformities, overgrowth of scar tissue leading to bowel problems,
and potentially deadly placental abnormalities in subsequent
pregnancies.

And though most women with a prior cesarean are being encouraged and
often coerced into having repeat cesareans by their doctors and
hospitals that have banned vaginal birth after cesarean (VBAC), a pair
of recent studies done by the National Institute of Child Health and
Human Development Maternal–Fetal Medicine Units Network demonstrates
that women who deliver vaginally after a cesarean fare significantly
better than women who deliver by repeat cesarean. (Obstetrics &
Gynecology 2008;111:285- 291, Labor Outcomes With Increasing Number of
Prior Vaginal Births After Cesarean Delivery, Mercer et al, and
Obstetrics & Gynecology 2006;107:1226- 1232 Maternal Morbidity
Associated With Multiple Repeat Cesarean Deliveries, Silver et al.)

"Most women are looking to avoid cesareans. But physicians often make
surgery difficult to avoid by insisting on non-evidence based
practices," said Udy. Practices that fail to improve the outcomes for
mothers and babies and increase the risk of cesarean section include
inducing for going post-dates, inducing for suspected large baby,
requiring fasting during labor, requiring women to be confined to bed
for continuous fetal monitoring, and failing to offer continuous support
to a mother in labor. "These care practices serve the system well, but
not mothers and babies" Udy added.

In fact, women and their babies may be paying a higher price than being
denied health insurance. Last August, the Centers for Disease Control
reported that, for the first ime in decades, the number of women dying
in childbirth has increased.  Experts note that the increase may be due to better reporting of deaths but that it
coincides with dramatically increased use of cesarean. The latest
national data on infant mortality rates in the United States also show
an increase in 2005 and no improvement since 2000.
 

Internationally, the U.S. ranks 41st in maternal deaths
and has the second worst newborn death rate among industrialized
nations.

Women who are seeking information about how to avoid a cesarean, have a
VBAC, or are recovering from a cesarean can visit www.ican-online
<http://www.ican-online> . org for more information. In addition to more
than 90 local chapters nationwide, the group hosts an active on-line
discussion group that serves as a resource for mothers.

Women who want to reach their lawmakers can visit
http://www.votesmart.org <http://www.votesmart.org> . Women who want
to reach their state insurance commissioner can visit http://www.naic
<http://www.naic> . org/state_ web_map.htm .

Mission statement: ICAN is a nonprofit organization whose mission is to
improve maternal-child health by preventing unnecessary cesareans
through education, providing support for cesarean recovery and promoting
vaginal birth after cesarean. There are 94 ICAN Chapters across North
America, which hold educational and support meetings for people
interested in cesarean prevention and recovery.

Contact: Gretchen Humphries (734) 323-8220

Deborah Bartle LM, CPM, CHt., CCE, CD