Comments on: Removing Financial Incentives for Unnecessary C-Sections

By: uberVU - social comments

uberVU - social comments — Thu, 31 Dec 2009 06:13:25 +0000

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By: MomTFH

MomTFH — Tue, 01 Sep 2009 04:28:06 +0000

Yes, yes, medical student and residency training need to be addressed. On rotations, students want to scrub in and suture cesareans. They want t o catch babies, too. It just depends on where the program is where they are doing training.

I haven’t seen a list of cesarean rates at residency programs, but I would like to. At the program closest to me, the cesarean delivery rate is 53%. Residents are under pressure to perform a certain amount of procedures. I have no idea how this effects cesarean rates at these programs.

By: Christa

Christa — Fri, 28 Aug 2009 15:09:20 +0000

Yeah for Washington for taking the first steps. There are far too many interventions in birth causing unessary c-sections. If doctors quit inducing (because your body isn’t obviously ready) then maybe the rate would go even lower. I bet if they are getting paid less for a c/s, they’ll quit inducing women who’s bodies aren’t ready, that might otherwise end in a c/s.

I hope all the states follow suit & it really truely does bring down the c/s rate. If nothing else it’s at least a step in the right direction at an attempt to lower the rates & the health care costs.

By: Judith Lienhard

Judith Lienhard — Tue, 25 Aug 2009 22:48:46 +0000

And how are Physicians reimbursed under this plan? Does this mean that a hospital will receive the same amount for a 2 day stay after a vag delivery vs 3-4 days after a C/S?
Yes, we do need more midwives instead of surgeons for healthy women and need midwives at the bedside willing to labor sit. I work as a maternity nurse and it is a rare labor where the midwives spends much time at the bedside, sorry to say.
We need trust in birth, more mentoring for new doctors and midwives. We need providers who during training would be required to spend time labor sitting, spend time at a birth center and see true spontaneous births.
I do think we need to take out the financial incentives for C/S and I applaud WA state for their initiative!

By: Rachel

Rachel — Tue, 25 Aug 2009 12:58:45 +0000

Thank you all for your suggestions of additional ways to address this issue – inspiring!

MomTFH, would you also add med student training to the list of things to change, given your experiences? I know I’ve heard some non-evidence-based things from a nursing student friend or two.

By: mrs spock

mrs spock — Mon, 24 Aug 2009 22:05:33 +0000

I, too, think this is hitting it from the side, though I guess time will tell if equalizing payments will have any effect on c/s rates. I think the way physician’s time is managed has the largest impact on rates. Trying to fit labor into a jam-packed schedule will mean a labor will bend to fit the schedule, and not the other way around.

To the previous commenter, RNs do not have the time to provide labor support because hospitals, who hire and staff L & D units, refuse to staff them on a 1:1 ratio. As an RN myself who has worked worked L & D, I think you will find there are many nurses who go into that field with a midwife mentality, and who would love to provide that direct support- we just aren’t given the option to do it. It was the #1 reason I left L & D. That said, I would love more access (as in, paid for by insurers) to continuous support like CNMs or DEMs.

By: MomTFH

MomTFH — Mon, 24 Aug 2009 17:51:23 +0000

Well, Hildy, if Washington state is anything like Florida, most of these women don’t even qualify for Medicaid until they are pregnant. And, coverage of birth control by public or private insurance is controversial and spotty, not to mention coverage of abortion by public or private insurance being an even bigger wedge issue. By the time we’re talking about who is paying for the delivery, it’s too little too late.

By: Hildy

Hildy — Mon, 24 Aug 2009 16:15:29 +0000

Nobody noted that half of all births in Washington state are paid for by Medicaid? That sounds a bit high to me… or it should be. It suggests that there are a lot of children being born into poverty, which makes promises like “no child will be living in poverty” rather useless.

By: Tiffany

Tiffany — Sun, 23 Aug 2009 23:33:35 +0000

While I think Washington’s approach to lowering the section rates in that state should be applauded, I think that they are attacking this from the side instead of head on.

Sections done for just cause are appropriate but what we really need to look at are the sections being done for convenience and for lack of appropriate labor management. I don’t even need to discuss the first reason. The second reason is where the attention needs to be. Having midwifery care can make a significant impact on the c/s rates…so why aren’t we pushing this option of care more? Midwifery involves actual labor support and management of labor by a qualified professional as opposed to a RN managing the labor and calling the doctor with updates or for delivery. The reality is that RNs do not have the time to provide labor support, and in this day and age, the skills necessary to do it.

By: Rachel

Rachel — Fri, 21 Aug 2009 21:15:22 +0000

Thanks for your comment, MomTFH – I definitely think there are multiple factors in play here. I wonder how many places have salary pay now and what their rates are like?

The fun anti-spam words were Christine’s doing – I got “Sotomayor”