Realigning the C-section incentives

Check out my new piece on Crosscut about steps Washington state is taking to reduce C-sections by, as President Obama would say, "realigning incentives. It's on the homepage right now; find the permalink here.

Parade's push for child care

Parade, that feminist rag. Who knew? Perhaps only the unassailably bland newspaper insert could get away with such an unapologetic insistence on the critical need for affordable, high-quality child care, calling it not just a crisis, but a 25-year-old one that is past due for solving.

The choice of anecdotes to lead “The New Push for Quality Child Care” with is deft: Timisha Daniels describes leaving the work force after having a child, deciding that child care would eat up too much of her salary and not trusting child care much anyway. Now her husband is laid off, she’s been struggling to find work, and she wishes she had made a different decision. The story neatly, but gently, illustrates the economic forces that steer women to ever so reasonably enter traps.

The author puts America’s refusal to provide social benefits to mothers in unflattering context by explaining that, “In European nations, high-quality child care, especially for 3- to 6-year-olds, is seen as a right of citizenship. Governments view it as an investment in the nation’s future, and excellent facilities with top-notch care are plentiful,” and noting that the only countries that fail to offer paid parental leave besides the U.S. are Lesotho, Papua New Guinea, Liberia, and Swaziland.

Gotta love the blithe sweep of “experts on family issues and child development say the realities of the 21st century demand” social support for child care. (Finally, a journalist uses “experts say” to good ends.) None of this is really groundbreaking, except that after all these decades of day care horror stories and the assumption that child care is a necessary evil, it’s a delight to read so unwavering a disposal of all that. In Parade!

It’s all a little less surprising if you notice that the author is Leslie Bennetts, former New York Times reporter, Vanity Fair contributing writer, and author of The Feminine Mistake, one of the recent salvos in the quote unquote Mommy Wars. Here’s the blurb on the book:

…Women are constantly told that it’s simply too difficult to balance work and family. Not only is this untrue, Bennetts says, but the arguments in favor of stay-at-home motherhood also fail to consider the dangers of dependency and the difficulty of reentering the workforce after opting out. When women sacrifice their financial autonomy by quitting their jobs, they become vulnerable to divorce as well as the potential illness, death, or unemployment of their breadwinner husbands.

Timisha Daniels, exhibit A.

"Nonworking parents"?

I have a snowball's chance in hell of getting this letter published in The New York Times. But as The Daily Show* would say, who needs the old media? I have a blog!

Therefore:

To the editor:
A phrase in the July 5 article “Safety Net Is Fraying for the Very Poor” made me scratch my head. “Nonworking families with children”? As a parent of two small children, I know that no parent is nonworking. I think the phrase the reporter was looking for was “nonearning parents.”

This isn’t just semantics. Accepting that parenting is a socially valuable job that the market fails to remunerate implies providing social benefits to parents, such as paid family leave and what you might call parental wages—welfare without the stigma, without the punitive restrictions and narrow time limits, and with benefits robust enough to actually remove becoming a parent from the list of leading causes of poverty spells. This would mean a repudiation of welfare reform’s insistence on “pushing single mothers into jobs” (as if they didn’t by definition already have them), a policy whose shortcomings your article highlighted.

* Ridiculing newspaper reporters for...using land lines? Excuse me, but just where does Jon Stewart get the loads of good information that go into his monologues? The New York Times and other sources of "aged news." Criticize The New York Times for its failures of journalism, like boosting the case for the Iraq War (which the Daily Show did, briefly), but not for using land lines. (How many times has your cell phone dropped a call--do you want to be the reporter getting the big scoop from a whispering source and having to say, "Can you repeat that louder? What was that? You're breaking up"? Let's hear if for land lines.) This segment was juvenile, unfunny, and plain old mean.

Breastfeeding a crime?

If you thought staying home was the way to avoid being hassled for breastfeeding, watch out for BWI. That’s Breastfeeding While Intoxicated, and apparently it’s a crime, even when done in the privacy of your home. A North Dakota woman was jailed after cops were called to her house on a report of domestic violence, when she appeared drunk and she nursed her baby in front of them. Now the woman is in jail, facing up to five years in prison, and her nursing baby has been taken away from her.

Comments from one of the cops suggests that it wasn’t the drunkenness that got her arrested. It was the breastfeeding. Grand Forks Police Lt. Rahn Farder told the AP, "It is quite unusual for a mother to be breastfeeding her child as we are conducting an investigation, whether she was intoxicated or not." It actually sounds like good parenting in a very stressful circumstance. With cops bursting in and a man possibly having just beaten up the mother, the baby was probably screaming her head off, and there isn’t any better way I know to quiet and soothe an upset baby than breastfeeding.

While it’s probably not healthy for a nursing baby’s mother to be repeatedly intoxicated, there’s no evidence that breastfeeding during a single episode of drunkenness harms a baby at all, as a doctor blogging at Skeptical OB notes. On the other hand, the doctor says, feeding a baby a bottle while drunk actually might be harmful, because mixing formula in the wrong proportions could harm a baby. Yet all the details of the story suggest that the police would not have arrested her if she had been feeding the baby a bottle.

And of course separating a nursing baby from its mother is clearly harmful.

According to Salon, the cops didn’t do a blood alcohol test on either the mother or the baby.

What about the domestic violence that brought the cops to the house? The boyfriend who was likely the cause of the mom’s beat-up face was not charged. And people wonder why women don’t report domestic violence more often.

The mother has apparently pleaded guilty to the charges, which suggests she had a very bad lawyer. The case reeks. Where’s an ambulance-chaser when you need one? ACLU, somebody, sue the pants off that police department.

BTW: Love the Skeptical OB on this story and her point about Americans’ inability to assess relative risk (including her dig about the risk of putting kids in automobiles). She’s got some whiggy ideas about homebirth, though. I suspect she’s using bad data on homebirth safety—I look forward to checking into it.

Health care reform and midwives

Below find an open letter from Suzy Myers, midwife and women’s health care pioneer. Certified Professional Midwives, whom she represents, are the midwives who practice independently, outside of hospitals, i.e. at home births or freestanding birth centers. The other kind of midwife is nurse midwives, who largely practice in hospitals. If CPMs are federally recognized, covered by Medicaid, and become more widely used, the U.S. could save millions, perhaps billions, of dollars on childbirth while improving care.

June 20, 2009

We are at a moment in history that could affect the future of midwifery for decades. We have the opportunity to positively influence health care legislation to ensure access to midwifery care or be left behind as details of a reformed system are established in law in the next few months.

The M.A.M.A. campaign is a historic coalition of the key midwifery and consumer organizations in the U.S. unified behind the goal of achieving federal recognition of Certified Professional Midwives. Our specific goal in the next weeks is inserting an amendment into the health care bills that are moving through congress right now to mandate Medicaid coverage for CPM services on the federal level.

This multi-faceted campaign is being directed by a steering committee of dedicated volunteers, and paid staff: an experienced lobbyist in Washington D.C. , campaign coordinator and a project consultant with national health care reform experience and connections.

This week Amber Ulvenes, MAWS lobbyist and midwifery consumer, and I are participating in a country-wide “fly-in” of midwives and advocates to DC to work with the campaign’s federal lobbyist to amend this language into the Senate Finance bill when it goes to committee mark-up the week of June 22nd.

In addition to mobilizing grass roots support, right now funds are urgently needed to sustain this work through the next few months when legislation is being drafted.

What you can do:
1. If you are a midwife, talk with each of your current clients about the M.A.M.A. campaign. Give them the link to the web site: http://www.mamacampaign.or g/. Ask them to sign up, endorse, give money and volunteer to pitch in. If you have an e-list of past clients, please send a personal message asking for their support and directing them to the web site.

2. Send this message to everyone you think supports increased access to midwifery care and ask them to join the M.A.M.A. campaign and donate.

3. Sign up yourself! Numbers count. Dollars count. This is a moment when we must mobilize all available resources!

Thank you,
Suzy Myers
Midwives Association of Washington State Board of Directors
National Association of Certified Professional Midwives Board of Directors

Childbirth: the low-hanging fruit of health care reform

Quick, what’s the number one reason to be hospitalized in this country? Heart attack? Car accident? Here’s a hint: It’s not a disease. It’s not even an injury.

The answer is childbirth. And what’s the most common operating room procedure? C-section.

Given that 85 percent of women give birth and it’s no secret how 240 million Americans arrived in the world, this shouldn’t be a surprise. Nor should it really be a surprise that maternal and newborn charges are far and away the nation’s number one hospital cost, $86 billion in 2006, according to Childbirth Connections. Given all this, you’d think that, as talk of health care reform, and especially containing health care costs, fills the media, childbirth would be a major topic.

You’d be wrong. I haven’t read a peep about it in all the newspaper and magazine articles on Obama’s drive to cut health care costs, except for a couple of good articles in USA Today last December, generated by a report from Childbirth Connections.

There’s been a lot of attention paid to the ways the country pays too much for the wrong kind of care. A recent article in the New Yorker made the point that some parts of the country spend much more on medical care than others, without being healthier for it, the moral of the story being that we can cut costs while improving care. Obama reportedly passed this article around to members of Congress (hallelujah, an intellectually curious president for a change).

Yet oddly the article didn’t mention childbirth, even though C-section rates vary wildly by region and by hospital, and the nation’s C-section rate is over 30 percent, more than double what the World Health Organization recommends, which is to say that half of all U.S. C-sections are unnecessary. USA Today estimates unnecessary C-sections per year cost the nation at least $2.5 billion a year, but that is surely conservative, given that there are probably 700,000 unnecessary C-sections, each costing at least $5,000 more than a vaginal birth (not to mention the costs from additional medical complications). Add in the other childbirth interventions—such as episiotomies or continuous fetal monitoring—that are routinely done far in excess of what evidence recommends, and there have to be tens of billions of dollars that could be cut from our spending on childbirth each year while improving care.

As a doctor put it to USA Today, "Fortunately, maternity care is a place where good care and good economics come together."

Why aren't other media covering this?

Thank you, Dr. George Tiller

I’ve been thinking all week about George Tiller. As sad and angry—particularly at the negligent law enforcement officers of Wichita—as his murder makes me feel, what I know about George Tiller’s life uplifts me. That there was a man who, knowing he was risking his life, dedicated himself to helping women gives me new love for half the species. Reading the newspaper—yet another story of a man who murdered his children to get back at his ex-wife, or hired someone off Craigslist to rape his wife at gunpoint—I often find myself consumed with misanthropy. (Wrong word, I know—it’s not humanity I’ve got a beef with—but there isn’t the right word. No coincidence, that.)

George Tiller reminds me that while men too often consider women’s freedom a threat to be countered with brutal violence, men are also capable of making the highest sacrifice to defend the right of women to self-determination. Thank you, Dr. Tiller.

Dr. Tiller was one of only four doctors nationwide who provided the kind of late-term abortions he did. As Salon asks, where will women—and sadly, girls—go now?

"We always sent the really tragic cases to Tiller." Those included women diagnosed with cancer who needed abortions to qualify for chemotherapy, women who learned late in their pregnancies that their wanted babies had fatal illnesses, and rape victims so young they didn't realize they were pregnant for months. "We sent him 11-year-olds, 12-year-olds."

To make a donation in Dr. Tiller’s name to the National Network of Abortion Funds, to help provide the kind of health care he did to poor women and women facing major obstacles to getting abortions, go here.