Back Alley Births
Published January 14, 2009 @ 05:58PM PT
Research Supports Birth Choices as Insurance and Hospitals Limit Them
Most women's rights advocates know the phrase "back alley abortions."This phrase was popular before the passage of Roe v. Wade, when anti-abortion laws were not effectively reducing the number of abortions. Instead, the restrictions were, in effect, putting women's lives at risk by increasing unsafe abortions in "back alleys" or other unsanitary locations with no assistance from medical professionals.
Today, abortion is legal in every state. But today, a new problem has arisen as now birth is being highly restricted.
Birth advocates are trying to garner media attention regarding the rise of "back alley births." For a long time, insurance companies have deemed pregnancy a "pre-existing condition." For women who switch insurance mid-pregnancy, this switch can leave the pregnant women without the ability to pay for needed medical assistance during her labor. In June 2008, the New York Times reported that insurance companies are refusing to cover women with prior c-sections whether they are pregnant or not, leaving those women uninsured unless they submit to a hysterectomy surgery to remove their uterus. See also the ICAN press release.
Even when pregnant women are able to obtain insurance, the insurance companies may limit the care they receive. For example, Kaiser refuses to compensate home births despite the fact that home births average costs less than $2000 and the typical cost for a cesarean birth (c-section) without complications can range between $14,000 and $25,000 or more! Just last fall, Aetna insurance announced that they also will not cover home births, and in addition, that they will not cover birth center births unless the birth center is attached to a hospital. Recently, Blue Cross Blue Shield made the only birth center in the Northern Virginia area an "out-of-network" provider, which will increase the costs to patients who choose to birth at home. These insurance companies are essentially limiting the women's right to choose to birth at home.
The problem, of course, lies in the fact that many women do not discover the restrictions by their health insurance company until it's too late. But, even for informed pregnant women who use a mother-friendly health insurance company, they may not be able to find a doctor to support them in their birth choices. In 2004, The International Cesarean Awareness Network (ICAN) exposed that over 300 hospitals in the United States completely ban Vaginal Birth After C-section (VBAC) even though VBACs are safer for most women than a repeat c-section. And, the entire state of Oklahoma has basically stopped giving pregnant women the option for a VBAC due to the medical malpractice insurance company , which will not cover doctors who offer VBACs to their patients.
With these multiple, severe restrictions on pregnant patients' established right to informed refusal, there is a clear violation of women's rights that we need to fight. But, in these cases, the injury goes significantly further than just the theoretical right. C-sections, while a life-saving surgery sometimes, are to blame for higher maternal and infant mortality rates, as well as long-term harm, like increased risk of infection and decreased breastfeeding rates besides countless other more minor dangers. Women who do not want to be subject to these restrictions - either because they underwent a painful c-section birth with their first child or were informed before their first birth - are often forced to seek a "back-alley birth." This means that they either have no assistance ("free birth") or they use an unlicensed midwife or a midwife practicing outside the scope of her license. These choices are more dangerous for high-risk women with previous c-sections than attempting a VBAC in a hospital setting. For women who cannot find a provider who supports VBACs, however, this is their only choice.
Just last week, the Wall Street Journal reported that a study in the New England Journal of Medicine shows that one-third of c-sections are done too early, putting the mother and infant at increased risk. With more and more studies showing that hospital interventions are dangerous, while more insurance companies limit coverage of out-of-hospital births, more and more women will be left to do "back-alley births."
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Comments (5)
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Author
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Shel Lyons is a lawyer, advocate, and mom with a focus on birth rights and family issues. She is a former Honors Attorney with the United States Department of Justice. In 2004, she received a clerkship with the Honorable Judge Sharon Prost. In 2005, she was awarded Harvard Law School's Heyman Fellowship for dedication to public service. She gave birth at home and is breastfeeding her cloth-diapered daughter. She grew up in the San Francisco Bay Area, and currently resides in the greater Washington, DC area.
I enjoyed reading your blog, and hope that things in Australia do not reach this level of medicalisation although it is getting there.
I firmly believe that obstetricians need to listen to the needs of women and reduce the c-section rate, otherwise we will force women into birthing without midwifery or medical assistance.
A more collaborative approach to care, working hand in hand with midwives would be a step in the right direction.
Posted by infomidwife PaulineRose on 01/15/2009 @ 12:43AM PT
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Actually, "back alley abortions" refers to the fact that doctors would let pregnant women seeking abortions into their clinics or private practices through the back-alley door rather than through the front door. Dr. Mary Calderone, past president of an abortion-rights organization in the 60s estimated that some 90% of all illegal abortions were performed by doctors or other medical personnel.
Other than that, great article! Very well researched with lots of great links.
Posted by Kathy Petersen on 01/15/2009 @ 06:03AM PT
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Dear Ms. Lyons,
You blog comment about "back alley births" is absolutely correct. I am a member of the Steering Committee of the Big Push for Midwives Campaign, which is working for licensure for certified professional midwives in states throughout the U.S. where the practice of midwifery is actually illegal. In some states, it is a felony and midwives have actually been arrested for attending births. Talk about "back alley" -- in these states, a woman may really have to go underground to find a midwife to attend her home birth. The Big Push is also working to bring the problems you describe to the attention of the transition team and recently submitted a 12-point document on needed reforms in maternal-child health care in the U.S. -- including reining in the skyrocketing cesarean section rate, ending vbac bans, increasing access to midwives and birth centers under the federal Medicaid and Federal Employees programs, and including midwives and birth centers in health care reform proposals.I would like to follow up with you on these issues. I am in the process of forming a National Birth Law Center, which would include a Birth Lawyers Network, so that those of us who are practicing attorneys can use our legal skills to help women facing VBAC bans, denial of informed refusal, etc.
Warm regards to you,
Susan Jenkins
The Big Push for Midwives Campaign
www.thebigpushformidwives.org
Posted by Susan Jenkins on 01/15/2009 @ 10:37AM PT
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THANK you for writing this! I agree that this issue goes hand in hand with other women's rights issues, specifically abortion rights. It seems that this is the latest way to take away a womans autonomy and to once again ensure we have less rights the second we get pregnant. Since there is so much fear surrounding birth, and so much misinformation, it seems to be off many people's radar. I myself considered myself a feminist and well read on the issues, yet walked right into my c-section trap. I had no idea what had happened until it was all over. I have since had a succesful VBAC and am working on legislation to prevent VBAC bans. I am relieved to see this on the feminist blogs and hope there will be more to come. Unfortunately, I fear we will see the c-section rate continue to climb before it starts to change again.
Posted by Heather Deatrick on 01/15/2009 @ 02:16PM PT
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Wow. These comments are very supportive and insightful. Although Kathy Peterson makes a needed correction to the article (thank you Kathy), there is no contrary view. Does that mean that there is a universal understanding of the need for change right now? Or, are the doctors who practice this medicine and the insurance companies that issue these policies to embarrassed to share their views? Please let me know who supports back-alley births, who supports restricting a women's reproductive rights, who supports rising c-section rates. I sincerely would like to know these views, if there is any rationality to them, so that we can direct the research to solving the problems that are hurting mothers and their babies. Otherwise, let us stop such nonsense and empower mothers to make decisions on what is best for their bodies and their children, especially when it results in lower health costs now and in the future! If you have ideas for future articles on birth advocacy, please message me at any time.
Posted by Shel Lyons on 01/16/2009 @ 09:50PM PT
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