Very interesting. I think we are gong to see a lot of financial legislative changes that will ultimately drive practice. While I can’t say what impact THIS particular change will have I actually think over time many of these changes will ultimately benefit women. At least I pray they will :-/

While it seems TennCare is not getting the expected result, I have to applaud them for their efforts! Down here in Florida, their great solution is to cut funding for Medicaid patients going to birthing centers (a considerably cheaper option than hospital birth). The weather may be great down here, but the politics are terrible!

Could you explain your reasoning process step by step to show how you arrived at the personal opinion that OB-GYNs made the “admission” that you’d like to pretend they made

I don’t see anything in that article, or your analysis of it, that justifies your assumption.

Let me give you a legal example as a parallel. Suppose public defenders protested about government cuts in reimbursement for “unneeded” representation of the guilty. Would you assume that “unneeded” representation of the guilty, poor Tenneseans no less, are keeping many public defender programs afloat in the first place?

I use the legal example because it is comparable in many ways. There is no reason to provide trials for the guilty. And it is true that most defendants are guilty. However, some defendants are innocent and it is often difficult to tell in advance which ones are the innocent ones. We provide trials for everyone not so public defenders can profit from state money, but because we consider it more important to make sure that no innocent people go to jail.

Similarly, TennCare wants to claim that there is no reason to pay for “unnecessary C-sections.” And it is true that there is no reason to pay for unnecessary C-sections and that many C-sections are unnecessary in retrospect. However, a substantial portion of C-sections are life saving and (because of the limitations of current technology) it is often difficult to tell in advance which ones are the life saving ones. We pay for all C-sections because we consider it more important to make sure that no babies die preventable deaths.

I also used the example, because I think most people will understand it. Debates on the appropriate reimbursement of public defenders (or teachers, or police, or fire fighters) have nothing to do with whether the public is getting services that they shouldn’t get. Similarly, debates on the appropriate reimbursement for the care of poor women have nothing to do with whether poor women are getting C-sections they don’t need.

The real point is that, rather than illustrating some elaborate evil conspiracy, the issue at the heart of this is Economics 101. When you cut aid for poor people, whether it is legal aid or medical aid, poor people suffer.

Moreover, TennCare is an insurance entity just like any insurance company. They insist that various instances of care are “unnecessary” in order to avoid paying for that care. Why on earth should poor people trust TennCare to make decisions based on patient wellbeing when other insurance companies attend only to the bottom line?

I know you really, really, really want to reduce the number of C-sections. However, depriving poor women and their babies of high quality medical care is a rather cynical way to go about it.

@Amanda – I am interested in knowing my “agenda” considering I am a 2 time c-section mother, having my third in 35 days… Just sayin’

Yeah, I’m not sure how they are “admitting” that they are doing it for the money. My father is a CEO at a hospital that serves a large portion of medicaid patients. When hospitals take Medicaid, they actually LOSE money. If a procedure costs the hospital $600 (paying the doc, nurses, medication,etc.) Medicaid only gives them a fraction of that cost. (Side note, I fully support Medicaid programs). Many hospitals are actually turning away Medicaid patients b/c they actually can’t afford to treat them. My father’s hospital takes everyone b/c they are committed to helping their community, but they end up having to cut free programs, etc. to pay for all of these patients. I believe that C-sections are way overused and we need to be more aggressive about preventing them and keeping them for emergencies. However, it is not all the doctor’s fault. The main reason OB’s’ suggest C/S so frequently is b/c for so long, they would get sued for something beyond their control. If people start suing their midwives for complications, midwives will stop doing homebirths too. It’s just too dangerous. To suggest that a doctor would recommend a c/s in order to get home for dinner is ridiculous. At most hospitals, an OB that is on call, is required to stay at the hospital for their entire shift. Perpetuating these myths only makes us look uninformed and our very real concerns about the rise in C/S gets ignored.

As a woman who is preparing for her second C-section (in Tennessee, no less) and also as the daughter of a physician, I see both sides of this issue. The problem is rarely the doctors here, but the government and hospital policies.
My first C-section was necessary, as I had breech twins (and my water broke…no time for trying to maneuver them!). This time, I am 29 weeks pregnant with one, with no complications thus far, but we’ve already settled on a C-section, for reasons that were mentioned above. There are very few doctors in the area who will do a VBAC (for malpractice reasons), and while the chance of uterine rupture is less than 1% (a statistic that my doctor did tell me), I prefer not to take that chance, as the mortality rate for that <1% is not good. I respect other women's choice to go ahead with a VBAC…it's their body, their baby, their choice. Although, I do not have TennCare, either, which is a state-subsidized healthcare for those without healthcare, which is a completely different issue that I don't want to delve into here.
Doctor's are people, too, and, believe it or not, the majority take the responsibility of caring for people and their health very seriously. A lot of doctors will tell you to go into nursing nowadays…good pay, flexible schedule, being able to do the job you want, but not having all the liability that doctors take on. If we want better healthcare policies, let's take it up with the government and hospital policy-makers and stop blaming our doctors.

Jessie, I would really look quite closely at the mortality rate for that >1%. It’s really quite low–I believe 1/10,000. Very similar to the mortality rate of repeat cesarean. The vast majority of uterine ruptures end with a healthy mom and baby. Not to say that I would like to have one by any means, but once I really looked hard at the data the decision to attempt VBAC became much easier.

In my local ICAN group we do have about a 1% UR rate (we have had hundreds of births over the last few years), one of them catastrophic. All mothers and babies are doing well. All of our URs occurred in a hospital.

this outrages me ! How dare doctors force c-sections on women who do not need them…I have been saying this all of my life to anyone who would listen..We are not stupid…we know that money is the root of all evil…there is a difference in someone who needs a c-section verses a doctor who does them because they want to pencil you in for 1pm…fill up his book for the day…and be off by 5pm and home for dinner or golf…hell set it up so that you know how much your gonna make that week and buy that new Rose ya been wanting…MF’s…I told my doctor exactly how it was gonna be !! believe me I will come up off that table and beat an ass…and if I can’t my mexican husband will and my 2 grown sons !! don’t mess with mamma…if I need it and my babies are in distress or I am..fine..do what ya gotta do..but don’t pencil me in …cause I will come unglued..no one is gonna rob me and my husband our once in a life time chance of watching our children born into this world..I made that very clear..and he said ok..ok..just letting ya know that is in an option..uh hello not from my point of view…it is plan B when plan A goes wrong..not an option !!