Over at Daily Kos, nyceve put up another shocking diary about the practices of for-profit insurance companies in the U.S.

Today she links to this article from the New York Times about women facing higher insurance premiums, or even being denied insurance coverage, after giving birth by cesarean:

Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

This problem could affect millions of American women:

In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.

“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.

Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.

The New York Times piece also mentions one woman who was rejected for coverage by the Golden Rule Insurance Company:

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

Great news–all she has to do to get health insurance coverage is be sterilized!

Seriously, we need a national health care policy that prohibits insurance companies from refusing to cover people with pre-existing conditions.

Until that happens, women would be advised to do whatever they can to reduce their risk of having a c-section.

Some surgical births are unavoidable, and in those cases it is a lifesaving procedure. However, there are ways to reduce the risk of having an unnecessary cesarean.

I advise women who are pregnant or planning to become pregnant to strongly consider using a midwife for your prenatal care, labor and delivery. Most midwives have a far lower cesarean rate in their practices than obstetricians.

One New Jersey hospital that has a thriving midwifery program has the second-lowest rate of c-sections in that state, “despite serving a low-income urban patient population that is more likely to have high-risk pregnancies.”

Hiring a certified doula to help the mother during labor and delivery has been shown to reduce the rate of cesarean births as well. You can have a doula assist you whether you are under the care of a midwife, an obstetrician or a family doctor, whether you give birth in a hospital, a birth center or at home.

You should also seek information about the c-section rates of the hospitals and birth centers in your area, if you have a choice. As I mentioned  in this post on cesarean births in Iowa, the percentage of babies born by c-section can vary widely from hospital to hospital.

For more information on cesarean births and the benefits of having a doula, click here.