Rant: Health Care Reform/Pregnancy

Since Health Care Reform is a hot topic, let’s look at it from the per­spec­tive of preg­nancy and birth.

What revi­sions would most ben­e­fit preg­nant women, their off­spring, fam­i­lies and communities?

1. Reward healthy behav­iors. A sys­tem that pro­vides reduced pre­mi­ums for health care for women who exer­cise, eat well, do not smoke and are in a nor­mal weight range is evidence-based.

Yes! We could pro­vide finan­cial incen­tives for being healthy dur­ing preg­nancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.

2. Review best prac­tices. Is a 40 or 50% cesarean rate the best prac­tice?  Accom­pa­ny­ing the rise in cesarean births is grow­ing infor­ma­tion that babies born by cesarean are at increased risk for a num­ber of immune dis­or­ders. But the busi­ness model of med­i­cine rewards cesarean because it both pays the provider more and is defen­sive med­ical practice.

Fetal mon­i­tor­ing to deter­mine if a cesarean may be nec­es­sary, is wrong 3/4 of the time. In an effort to change this, guide­lines are chang­ing for the use of mon­i­tors dur­ing labor. What is the evi­dence that this change of prac­tice is ben­e­fi­cial? Will it lead to more or less mon­i­tor­ing, which may itself be an inter­ven­tion that can dis­rupt nor­mal labor?

3. Change the busi­ness model for health care. When we make finan­cial incen­tives for care providers, base them on best prac­tice, not on enrich­ing the mid­dle man. Cur­rently the pay­ers (insur­ance com­pa­nies) are mid­dle men, mak­ing money (i.e., con­duct­ing busi­ness) by charg­ing fees. They ration pay­ments for ser­vices in order to pay their own salaries and over­head. They do not actu­ally do any­thing pro­duc­tive. This is why sin­gle payer, gov­ern­ment, and health care coop options have been pro­posed. They elim­i­nate most of the cum­ber­some mid­dle layer.

Why does insur­ance pay for cesare­ans? Well, they will do it once. After all, the care providers have to prac­tice defen­sive med­i­cine. But, once you have a cesarean, you become a risk for the insur­ance com­pany (they know what the research says about cesare­ans and off­spring health prob­lems) and may be denied insur­ance. They can no longer afford you.

Because care providers are paid fee for ser­vice and must prac­tice defen­sive med­i­cine, preg­nancy and birth have become increas­ingly bur­dened with inter­ven­ing pro­ce­dures that do not nec­es­sar­ily pro­mote a healthy preg­nancy or birth process. How is this play­ing out? Increas­ingly, we see women giv­ing birth in what they per­ceive as a more sup­port­ive and health-inducing set­ting:  their own homes. Think of it this way:  many women now believe that it is safer to stay home than go to a hos­pi­tal to give birth.

Unless health care becomes about best prac­tices and healthy out­comes — not price, size, and get­ting paid for pass­ing money back and forth — the U.S. will con­tinue to have some of the worst maternal/infant out­comes in the devel­oped world.

Posted in baby, birth, exercise, health care, pregnancy | Tagged , , , , , , , , , , , , , , , , , | 1 Comment

Pregnancy Pathway, Preconditions

Please refer to Feb­ru­ary 5 entry for com­plete graphic. Today we turn to the ques­tion of pre­con­di­tions to preg­nancy and how they might affect mater­nal and off­spring health.

Preconditions

Pre­con­di­tions

Pre-existing fac­tors that can influ­ence health out­comes include genetic fac­tors (fam­ily risk for heart dis­ease, for exam­ple), envi­ron­men­tal fac­tors (liv­ing in a build­ing with mold, for exam­ple), and behav­ior (eat­ing well and exer­cis­ing, for exam­ple). In each cat­e­gory, fac­tors will con­tribute to the health of the mother and even­tu­ally to off­spring health.

It is impor­tant to under­stand what major genetic fac­tors may affect your off­spring and whether the envi­ron­ment or behav­ior can help off­set neg­a­tive fac­tors. For exam­ple, there may be a his­tory of preeclamp­sia dur­ing preg­nancy in your fam­ily, but vig­or­ous aer­o­bic exer­cise in the six months prior to preg­nancy pro­vides a high degree of pro­tec­tion from this risk. Preeclamp­sia puts both mother and off­spring at risk for complications.

Other genetic fac­tors that may be of con­se­quence include autoim­mune dis­or­ders, aller­gies, and meta­bolic syn­dromes. For exam­ple, so-called “thrifty genes” may pre­dis­pose you to a high weight gain in preg­nancy. But, you may be able to off­set health prob­lems asso­ci­ated with this by stay­ing active and eat­ing well.

Posted in Pregnancy Pathway | Tagged , , , , , , , , , | Leave a comment