The Principal Financial Group lowered the boom on 300 workers in central Iowa yesterday:

Principal Financial Group laid off 550 employees Tuesday, including 300 in its Des Moines headquarters, the company said.

Principal, one of the area’s largest employers, has approximately 16,400 employees worldwide and 8,000 in the Des Moines area. […]

The Des Moines-based insurance and financial services company said the cuts are due to continued deterioration of U.S. and global markets.

Principal reported a net income of $90.1 million for the third quarter, a 61 percent decrease from $232.3 million in the same period a year ago. Principal also told a state development agency last month that it is no longer interested in receiving tax incentives in exchange for creating 900 jobs in Iowa.

The last day for most affected employees will be Dec. 31, and all affected employees will receive severance and career assistance, the company said.

It’s great that people will receive severance pay and career assistance, but they will be entering a very tough job market. Other local employers, including Wells Fargo Home Mortgage, have already laid off workers this fall. Finding a job with pay and benefits comparable to what Principal offered won’t be easy.

This isn’t just an issue for central Iowa. As nyceve writes in her latest diary, rising unemployment is expected to greatly increase the number of Americans lacking coverage for basic health care. Add that to the list of problems with our costly and inefficient employer-based health insurance system.

Doctors go through a lengthy period of education and training before they are certified to practice medicine.

So why are insurance company bureaucrats routinely able to second-guess or overrule doctors’ orders?

Rekha Basu’s column from the Sunday Des Moines Register provides another shameful example of this common practice. Last December, Angela Ira’s 18-year-old son Nicholas, who had a history of depression, severe anxiety and borderline agoraphobia, was suicidal.

Scared and desperate, she said she persuaded him to go with her to the hospital emergency room, though he fears leaving the house. The doctor threatened to have him involuntarily committed if he didn’t agree, said Ira. She finally talked him into it. But half an hour later, the doctor returned to say the insurance company refused to pay. […]

Magellan’s clinical director, Steve Johnson, said he couldn’t discuss individual cases. But in the letter to Nicholas mailed last Dec. 10, Magellan cited as reasons for the non-authorization:

– “You do not appear to be a danger to yourself or others, and you are capable of activities of daily living.”

– “The information provided supports that other services will meet your treatment needs.”

– “You no longer have the symptoms and/or behaviors you had on admission, and you have shown progress in meeting your treatment goals.”

How could the company determine, when Nicholas’ doctor was saying he was suicidal, that he was making progress toward goals? The letter said, “If we disagreed with your provider’s clinical decision, we consulted with a licensed psychiatrist or other qualified professional and recommended an alternate service.”

As if someone who hadn’t met or spoken to the patient could better understand his needs than the doctor treating him.

Conservatives love to demagogue about “government-run health care,” but I notice that they don’t seem bothered when insurance company employees deny access to treatment recommended by the patient’s own doctor.

Basu’s column is a reminder that even Americans who have private health insurance are often forced to go without medical care they need.

Barack Obama and the Democratic Congress need to stop insurance companies from substituting their judgment for that of doctors. This needs to be part of a broader universal health care package.

The Des Moines Register’s editorial board again called for single-payer health care reform in an unsigned editorial today:

Our view: What’s needed is a government-administered health-insurance program – similar to Medicare, which covers seniors and disabled people – available to all Americans.

A single system could reduce administrative expenses associated with facilitating thousands of different private health-insurance plans in this country. It could increase leverage for negotiating lower prices. It could facilitate the expansion of electronic medical records, which would streamline paperwork and help prevent costly medical errors. It would boost the country’s economy in the long run.

Every health care delivery system has its flaws, but on balance I agree that a Canadian-style single-payer system would serve this country well. A few days ago DCblogger chided me for my “defeatism” about the prospects for enacting single-payer. I stand by my assessment, though. Even if President Obama were fully committed to “Medicare for all,” getting HR 676 through Congress would be extremely difficult. But Obama has not endorsed single-payer and is not going to put his political weight behind it, even if 93 members of Congress have co-sponsored the bill.

This is an open thread for any comments related to health care or health care reform proposals.

UPDATE: The latest from nyceve continues to make the case for single-payer, with lots of statistics on the high cost of our for-profit health insurance industry. Naughty Max Baucus: “The only thing that’s not on the table is a single-payer system.”

I don’t expect to get everything I want from Democratic politicians in power. Probably liberals like me will have plenty of disappointments in the coming years. But if Barack Obama and the Democratic Congress only follow through on one big campaign promise, I hope it’s health care.

The many injustices of our current health care system have been thoroughly documented by nyceve, among others, but I want to add my two cents.

The 46 million Americans lacking health insurance represent one very large part of problem. Some can’t afford insurance, and others can’t find a private insurer who will sell them a policy for any price. You could spend all day listing the ways uninsured Americans get a raw deal on health care. They can’t afford preventive care and routine diagnostics, so they are more likely to be diagnosed with late-stage, incurable cancer. They are less likely to receive care for any number of chronic illnesses. They live with terrible, crippling pain. Few Americans without health insurance coverage are able to receive organ transplants, though many become organ donors after dying prematurely.

We need to get these people covered and get away from our broken employer-based health care system. Every day Americans who thought they had good benefits are joining the ranks of the uninsured–like my friend whose husband got laid off in October, right before his employer (a small manufacturer) went under. It turned out the boss had secretly stopped paying the health insurance premiums some time before. Or the retirees who worked at Maytag or at John Deere for many years and are now losing some of the health benefits they were promised.

Employer-based health care is also a huge drag on large corporations and our national economy, as clammyc pointed out in this recent diary.

In an ideal world, I’m for a Canadian-style single-payer system (also known as HR 676 or “Medicare for all”), but as a political compromise I would settle for something like what John Edwards and Hillary Clinton proposed during the primaries: mandatory health insurance, which would be portable with no exclusions for pre-existing conditions, and the option for any American to buy into a public insurance plan. Momentum is building in Congress for this kind of reform.

But getting Americans health insurance will solve only part of the problem. It’s shocking how many Americans with “good” insurance go without needed medical care. Only occasionally does a case makes national news, as when the teenager Nataline Sarkisyan was unable to get a liver transplant last year. A recent study found many Americans with chronic illnesses forgo medical care for cost reasons, even if they have insurance.

Then there are the “lucky” people who get the care they need for a medical emergency, but later face financieal ruin when their insurance company denies coverage. Medical bills are implicated in about half of all personal bankruptcies in the U.S.

When I had a medical emergency last winter, I got to the doctor relatively early, I received good care in the hospital, no lasting damage was done to my body, and my insurance company covered almost all of the costs (once we had exhausted our deductible). I remember our relief when the biggest bill arrived in the mail, for about $18,000, and our required payment was only $600. (I recognize that $600 would be a hardship for many families, but we are fortunate to be able to pay that without cutting back on any essentials.)

Yesterday I was reminded again of how things could have turned out very differently for my family. If you are a regular at Daily Kos, you may recognize the handle AdmiralNaismith. Among other things, he wrote a series of diaries about the political scene in all 50 states between April and October. The links to all of those pieces are here, and he wrote an interesting post-election wrap-up diary here.

AdmiralNaismith doesn’t write many personal diaries, but he recently discussed his own family’s “medical horror story”: Drowning in medical bills, despite insurance (another link is here).

He describes the sequence of events, including his wife’s life-threatening embolism, which left his family owing thousands of dollars for medical care–more unpaid bills than AdmiralNaismith earns in three months. He asked fellow bloggers to help pay down the three largest bills, which will otherwise be sent to collection agencies within 30 days. (He’s not asking anyone to send him money directly but provides contact details for the insurer, with name and account number.) A few hundred people paying $10 or $20 each would help enormously.

I will be calling to make a payment on Monday, and I encourage anyone who’s ever benefited from reading AdmiralNaismith’s informative diaries to do the same.

But equally important, I ask the community of Democratic activists, who did so much to elect Obama, to hold his feet to the fire next year on delivering the comprehensive health care reform he promised.

I haven’t been thrilled with Obama’s cabinet appointments so far. My number one hope for the new government is that Ezra Klein is right about what Tom Daschle as secretary of Health and Human Services means:

This is huge news, and the clearest evidence yet that Obama means to pursue comprehensive health reform. You don’t tap the former Senate Majority Leader to run your health care bureaucracy. That’s not his skill set. You tap him to get your health care plan through Congress. You tap him because he understands the parliamentary tricks and has a deep knowledge of the ideologies and incentives of the relevant players. You tap him because you understand that health care reform runs through the Senate. And he accepts because he has been assured that you mean to attempt health care reform.

Please share your thoughts or health care horror stories in the comments.

Jed L brought something remarkable to my attention over the weekend.

Michael Cannon of the conservative CATO Institute wrote a piece called Blocking Obama’s Health Plan Is Key to the GOP’s Survival. The idea is that if Obama gets universal health care passed, he will bring “reluctant voters” into the Democratic coalition. The Republicans must at all costs provent that from happening.

David Sirota and TomP both pointed out that conservative pundit William Kristol made the same case to Congressional Republicans during Bill Clinton’s first term. At first, some were afraid to be seen as obstructing the president’s health care reform efforts. But in December 1993,

Leading conservative operative William Kristol privately circulates a strategy document to Republicans in Congress. Kristol writes that congressional Republicans should work to “kill” — not amend — the Clinton plan because it presents a real danger to the Republican future: Its passage will give the Democrats a lock on the crucial middle-class vote and revive the reputation of the party. Nearly a full year before Republicans will unite behind the “Contract With America,” Kristol has provided the rationale and the steel for them to achieve their aims of winning control of Congress and becoming America’s majority party. Killing health care will serve both ends. The timing of the memo dovetails with a growing private consensus among Republicans that all-out opposition to the Clinton plan is in their best political interest. Until the memo surfaces, most opponents prefer behind-the-scenes warfare largely shielded from public view. The boldness of Kristol’s strategy signals a new turn in the battle. Not only is it politically acceptable to criticize the Clinton plan on policy grounds, it is also politically advantageous. By the end of 1993, blocking reform poses little risk as the public becomes increasingly fearful of what it has heard about the Clinton plan.

Getting back to Cannon’s recent piece for CATO, I am struck by how conservatives don’t even believe their own propaganda about the horrors of “socialized medicine.” Yes, I know that Obama isn’t proposing socialized medicine (which would work like the Veterans Administration, where the government employs the doctors and runs the hospitals), or even single-payer health care (as in Medicare, where patients choose the doctor but the government pays the bill). But for the moment, let’s accept CATO’s frame on this issue, which is that Obama’s health plan would turn into socialized medicine.

Obama’s plan would presumably allow Americans to buy into a state-run health insurance plan as an alternative to private health insurance, and would prohibit insurers from excluding people with pre-existing conditions. These measures would force the insurance companies to compete for customers by offering better coverage, as opposed to the current system, in which they try to maximize profits by denying care whenever possible, and sometimes refusing to insure people for any price.

I have a friend with a thyroid condition. At one point her husband was between jobs and they looked into buying their own health insurance. They could not find any company that would take their family. It wasn’t a matter of excluding coverage for anything related to my friend’s thyroid condition. They simply declined to sell insurance to this family at any cost. Fortunately, my friend’s husband got a job with good benefits. Otherwise, they would be uninsured to this day.

The benefit of giving families like my friend’s the option of buying into state-run insurance program is obvious. But let’s assume that conservatives are right, and that any state-run insurance scheme is bound to be expensive and inefficient. If that’s the case, wouldn’t it fail in the marketplace?

Obama’s health care plan could evolve in the direction of single-payer health care only if the government insurance plan provided superior coverage to consumers at a lower cost. CATO shouldn’t be worried about this, right?

Let’s go a step further. Conservative pundits are trying to tell us that Democratic health care proposals would be disastrous for the country and wreck the economy. If that’s true, then why is a CATO analyst worried that enacting Obama’s health care plan would cause a political realignment in the Democrats’ favor?

Cannon’s argument is also shocking on a moral level. He appears to believe that Obama’s health care plan would improve so many Americans’ lives that the GOP’s survival would be threatened. So, he urges Republicans to put their own political interests ahead of the interests of Americans currently lacking adequate health care.

Jed L thinks

Cannon has everything backwards: the GOP’s survival depends on Republicans being part of the solution instead of being part of the problem.

I have to admit that here I agree more with Cannon. Republicans would not get much credit for helping to pass Obama’s universal health care plan. Everyone would know it was a Democratic president with a Democratic Congress who delivered on that promise.

Obstruction with the goal of making Obama look like an ineffective leader in tough economic times is probably the Republicans’ best hope of making political gains.

I am cautiously optimistic that Congress will be more open to adopting Obama’s agenda than the Democratic-controlled Congress was for Bill Clinton in 1993 and 1994. We’ve got at least two things going for us: Obama’s Health and Human Services secretary will be Tom Daschle, who knows the inner workings of Congress, and Henry Waxman (not John Dingell) will be running the House Energy and Commerce Committee.

Via nyceve at Daily Kos I learned about a new study called “Class and Race Inequalities in Health and Health Care.” The three authors found that very few Americans lacking health insurance receive organ transplants, although the uninsured often become organ donors.

Eve’s diary includes a link to the full report in pdf format and summarizes one of its findings:

Strikingly, lack of insurance was a stronger predictor of organ donation than was any hospital characteristic or demographic factor other than age (older people’s organs are more often diseased and unsuitable for transplantation).

Why are the uninsured more likely to become organ donors? Could it be that more of them are dying prematurely?

The authors explain in the introduction why they embarked on this research project:

   “In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy.

   The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.”

Yes, you read that correctly. The patient was rejected for a heart transplant in part because, lacking health insurance, he was deemed unlikely to be able to buy the immunosuppressing drugs he would need to survive with a new heart.

Republicans scream about “socialism” and “rationing,” as if health care is not rationed every single day in this country. Maybe one of my Christian conservative readers can explain why it was ok to deny this young man a heart transplant. If his job had provided health insurance, he might have gotten that heart and be alive today.

Speaking of health care rationing, I learned from this MyDD diary that the academic journal Health Affairs recently published a study comparing care for chronically ill patients in eight countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States).

Click here to read the study, which found that “Chronically ill U.S. patients have the most negative access, coordination, and safety experiences.” I’ve excerpted some passages:

Asked about experiences, U.S. and German patients were significantly more likely than patients in the other countries to report wasted time because of poorly organized care. […]

The United States stands out in patient costs, with 41 percent reporting that they spent more than $1,000 out of pocket in the past year. […]

U.S. chronically ill adults were by far the most likely to report forgoing needed care because of costs. More than half (54 percent) reported at least one cost-related access problem, including not filling a prescription or skipping doses, not visiting a doctor when sick, or not getting recommended care (Exhibit 2). […]

U.S. patients were significantly more likely than those in other countries to report that medical records or test results were not available during a scheduled visit or that tests were duplicated unnecessarily. One-third of U.S. patients reported at least one of these experiences–a rate 30 percent higher than in any other country. […]

U.S. uninsured adults were significantly more likely than those insured all year to go without care because of costs and to wait when sick. Remembering that all in this study have chronic (often multiple) conditions, a disturbingly high 82 percent of the uninsured did not fill a prescription, get recommended care, or see a doctor when sick because of costs. Uninsured chronically ill adults were also more likely than those with insurance to report errors as a result of higher rates of delays in hearing about abnormal lab tests and wrong-dose/ wrong-medication errors. Not surprisingly, given these experiences, the uninsured were also more negative about the U.S. health system than insured adults were.

Still, the experience of fragmented and inefficient care in the United States cuts across insurance status. Insured and uninsured chronically ill U.S. adults reported similarly high rates of coordination concerns (duplication and records/tests not available) and perceptions of excess care or time wasted because of poorly organized care.

Although insured U.S. adults fared better than the uninsured, they were still more likely than their counterparts in other countries to forgo care because of cost and to encounter poor coordination. Their perceptions of waste, patient-reported errors, and negative system views also remained at the high end of the country range. […]

Repeating patterns observed in earlier surveys, the United States continues to stand out for more negative patient experiences, ranking last or low for access, care coordination/efficiency, and patient-reported safety concerns. The percentage of chronically ill U.S. adults who reported access problems, errors, delays, duplication, and other symptoms of poorly organized care was two to three times the level reported in the lowest-rate countries in the survey (a 20-30 percentage point spread). Along with Canadians, U.S. patients were also the most likely to indicate a primary care system under stress–lack of rapid access, difficulty getting care after hours, and high ER use.

Americans spend a higher percent of our gross domestic product on health care than any other industrial democracy, yet we don’t get good value for money. It’s worst for the uninsured, but as the above study found, even chronically ill patients with health insurance reported more problems with health care access than comparably ill patients in other countries.

I hope Congressional Democrats are serious about making big changes to our health care system, because the status quo is immoral and unacceptable.

UPDATE: More evidence that our current rationing of health care is immoral can be found in this diary by nyceve: “Many uninsured Americans endure terrible physical pain.”

MissLaura put up this front-page post at Daily Kos today about why unions matter. She linked to Change to Win, which has all kinds of useful statistics on its website. Click the link to find charts illustrating that “Union Workers Earn More,” “Union Members Have Better Benefits,” “Union Members Pay Less for Health Coverage,” and so on.

If Barack Obama becomes president, I hope he will follow through on promises to make it easier for workers to organize in this country. Replacing some of the corporate hacks George Bush has put on the National Labor Relations Board would be a step in the right direction. The Bush administration has used the NLRB to carry out a “systematic assault on workers’ rights.”

In the good news column, Shai Sachs reported in this post at MyDD that union membership appears to be slowly inching up, reversing a long decline.

But remember, just being in a union doesn’t guarantee that a worker will receive promised benefits. As I wrote a few weeks ago, Maytag retirees are probably going to lose health benefits guaranteed in their last contract. On the other hand, if they hadn’t been in a union, it’s a good bet they never would have had those benefits to begin with.

If you were negotiating an employment agreement, you might consider taking an outstanding benefits package in exchange for a lower starting salary or a wage freeze. How would you feel if many years later, in retirement, some of those benefits were taken away from you?

About 3,000 former Maytag workers and family members have received letters from Whirlpool this week informing them that they are about to get cheated. Here’s the background:

Whirlpool Corp. has filed a lawsuit in federal court seeking to cut the medical benefits of thousands of retired Maytag workers.

The lawsuit, dated July 24 and filed in U.S. District Court for the Southern District of Iowa in Des Moines as a class action complaint, names the international and local chapters of the United Auto Workers union and three retired Maytag workers as representatives of the class. […]

Whirlpool bought rival Maytag in 2006 for $1.7 billion and assumed the negotiated union contracts and related benefit plans. […]

Whirlpool said in the lawsuit that a contract negotiated between the union and Maytag in 2004 expires on July 31. Whirlpool said it plans to change the retiree medical benefits on Jan. 1, 2009, to bring the benefits in line with the same plan that more than 10,000 current employees, retirees and their dependents have.

I hope that Whirlpool’s lawsuit will fail, but unfortunately, the federal bench is so full of Republican-appointed judges that I don’t expect much in the way of protection for union members.

Barack Obama released this statement today in connection with the controversy:

Des Moines, Iowa – Below is a statement from Senator Barack Obama on the letter Whirlpool sent to Maytag union retirees this week about changes in their health benefits.

“In America, we believe that if you work hard, you should be able to build a better life for yourself and your family.  But today, this American dream is slipping out of reach for too many working Americans. Whirlpool’s decision to cut the health care benefits of 2,200 Maytag retirees is the latest sign that we need to change the broken system in Washington.  

“It’s not right that Maytag’s CEO walked away with a multi-million dollar buyout while the hardworking men and women who built the company lost their jobs and are now facing health care cuts. I’ve had the privilege of meeting with Maytag workers in Newton, and I know they negotiated those benefits in good faith, giving up pay increases and other benefits.  Now it is time for Whirlpool to show good faith to their former employees.  

“As President, I will fight for our workers every day because when our workers do well, America does well.  In the Senate, I’ve fought to protect pensions, and I will continue that fight in the White House.  I will make sure our workers get the fair wages, affordable health care, and secure retirement that they deserve.  And I’ll change our tax code so it rewards companies that create jobs here in the United States instead of companies that ship jobs overseas. I’ll be a President who looks out for Main Street, not just Wall Street and who fights to put the American Dream within reach for every American.”

I certainly hope Obama will work to strengthen labor unions and workers’ rights in this country if he gets elected.

But ultimately, Whirlpool’s action is yet another indictment of our health care system. Even Americans who have good employer-based health insurance can get screwed.

To get more informed about the failures of our current health care system and the benefits of moving to a single-payer “Medicare for all” model, read nyceve’s diaries at Daily Kos or the Guaranteed Healthcare group blog.

At Guaranteed Healthcare, you can also find a list of Democratic candidates for Congress who have endorsed HR 676, which would establish a single-payer health care system.

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.

Not long ago I posted about a poorly-researched and poorly-written article by the Associated Press on the rising rate of cesarean births in Iowa.

Lisa Houchins, a mom in Des Moines who is also education director for the International Cesarean Awareness Network, responded to the same article with this letter to the editor that the Register published earlier this week:

Regarding, “More U.S. Women Delivering Babies by Caesarean Section” (March 29): According to the World Health Organization, more than half of all Caesareans in the United States could be avoided. When used properly, a Caesarean can be a life-saving procedure. When used indiscriminately, C-sections introduce unnecessary risks to mothers and infants.

Women who deliver by Caesarean are more likely to have complications, including increased pain and recovery time, infection or death. Babies delivered by Caesarean are also more likely to suffer complications.

Women with Caesareans are at increased risk for miscarriage, infertility and complications in later pregnancies. Also, their future birthing choices can be severely limited. Some hospitals (including many in Iowa) and doctors are attempting to ban vaginal births after Caesareans.

Caesareans may be safer than they were 20 years ago, but that does not make them safer than a vaginal birth. C-sections are major surgery, and they should be reserved for times when there is a true medical indication. I encourage all pregnant women to educate themselves on how to avoid a Caesarean and how to have the safest and most satisfying birth possible.

April is Cesarean Awareness Month, and the ICAN website notes:

What is Cesarean Awareness Month? An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section.

Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It’s for daughters who don’t realize what choices are being taken away from them. It’s for scientists studying the effects of cesareans and how birth impacts our lives. It’s for grandmothers who won’t be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans.

CESAREANS are serious. There is no need for a ‘catchy phrase’ to tell us that this is a mainstream problem. It affects everyone. One in three American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world.

Be aware. Read. Learn. Ask questions. Get informed consent. Be your own advocate for the information you need to know.

There is lots of information on the ICAN website, so if you or your partner or your friend is pregnant, I encourage you to check it out. C-sections can be lifesaving procedures, but it makes sense to take reasonable steps to avoid having unnecessary surgery.

The ICAN of Central Iowa website has statistics comparing c-section rates in the largest Iowa counties and hospitals.

If you want to avoid a cesarean birth unless it is medically necessary, ask about c-section rates when you are choosing a provider.

Don’t induce labor without medical need (for instance, because you hit your due date, or because you don’t want to go into labor over a weekend), because trying to induce a cervix that isn’t ripe is more likely to lead to “failure to progress” and a resulting c-section.

Consider getting a certified doula to help with childbirth education during pregnancy and to support the mother during labor. The website of Doulas of North America explains the benefits of having a doula:

Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.

DONA International doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.

Numerous clinical studies have found that a doula’s presence at birth

   * tends to result in shorter labors with fewer complications

   * reduces negative feelings about one’s childbirth experience

   * reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans

   * reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:

   * Feel more secure and cared for

   * Are more successful in adapting to new family dynamics

   * Have greater success with breastfeeding

   * Have greater self-confidence

   * Have less postpartum depression

   * Have lower incidence of abuse

Click through to find links to some research. Dads, don’t worry about the doula trying to take your place during labor. My husband is a huge advocate for doulas. She doesn’t do your job–she just helps the mother with practical advice based on training and the experience of attending many births. She will not freak out to see the mother in pain, and she will be able to reassure both parents if panic sets in while labor is progressing normally.

I know women who would have ended up with c-sections if not for their doulas. In one case, the baby was presenting with the cheek rather than with the crown of the head. The medical staff were convinced a c-section was the only way to get that baby out, but the doula encouraged the mother to try leaning and squatting in some different positions during and between contractions. After a few tries, the baby shifted, and the rest of the labor was over in less than 20 minutes.

cross-posted at Daily Kos and MyDD

I am a healthy woman in my late 30s who rarely sees a doctor outside of regularly scheduled checkups. I have had two uncomplicated pregnancies followed by easy, midwife-assisted births.

Most years we pay far more in premiums for our family’s health insurance than our medical care would cost if we paid for everything out of pocket.

Not this year. Yesterday I returned home after spending seven days and six nights in the hospital. It might have been a lot worse if I were uninsured.