There is an interesting post on the Unnecesarean about a Utah Lawmaker who may propose cutting the use of epidurals to save money. It is creating some interesting comments.
Here is the basic idea from the Daily Herald:
Under the theory that perhaps thousands of Utah college students are having babies paid for by Medicaid that they could pay for themselves, one lawmaker has a plan: cut all elective epidurals and elective C-sections.
I think that in some ways this is a horrible idea, but in some ways it could change the birth climate! I would prefer it was for ALL moms (instead of punishing the poor). That even moms with insurance had to pay for their epidurals out of pocket.
What are some changes we may see if epidurals were not a paid option?
- More Moms would prepare for an un-medicated birth.
- Moms would educate themselves about their choices, which would lead to induction rates going down and then cesarean rates would drop.
- Hospital staff would be educated on how to support un-medicated moms. This would lead to moms getting more support.
- More moms may choose homebirths.
What else could the legislators/insurance companies/hospitals look at to save money?
- Cover midwifery care. :)
- Cover the cost of independent childbirth classes
- Cover the cost of doulas.
- Provide nitrous oxide as a comfort measure.
It is Cruel, unless they give them Tools!
In the comment section from Unnecessarean I read this:
Include me in the group of people who believe passionately that to deny pain medication to people in pain is grotesque. Imagine if your dentist said, you don’t really need novacaine for that filling! You don’t get to have it! I mean, there’s nothing *life-saving* about the use of anesthetic in many cases, including procedures like biopsies.
This is a great comment. If you don’t give people tools to handle the pain, then it can be cruel. However, what if people were given an alternative tool to stay comfortable, such as hypnosis? This can help people with dental work AND birth!
Interesting questions. I agree about the hpynosis — it truly does work, as I can attest from experience.
However, as for denying insurance coverage of epidurals …. frankly, I’d rather just see doctors and public health authorities giving expectant moms accurate information about the medical risks of epidurals. Lots of moms are willing to risk their own health for pain relief, but those same moms would go through hell ten times over to protect their babies. Which is why doctors are very careful to portray epidurals as risk-free for the baby.
The fact is, they aren’t. As a dyed-in-the-wool science geek, I did my research before giving birth and looked at the large scale studies that have been done on epidurals. As a result I totally ruled out an epidural even before I found my way to self-hypnosis. If I’d had to gut it out on my own, I would have. Because no way was I putting my baby at risk for temporary pain relief!
Epidurals contain powerful painkillers (in some case narcotics) that DO pass through the placenta to the baby. Typically the concentration of the drugs in the baby’s blood is about 1/3 of that in the mother’s. Compare that to the concentration of alcohol in a breastfeeding baby’s blood after mom takes a drink (1/100 of mom’s alcohol blood level), and you will understand that this is a truly serious issue.
Not surprisingly, babies born with epidurals have lower APGAR scores than babies born unmedicated. They also have poorer motor and social skills even one full month after birth. They are less likely to breastfeed (very important for long term health, as we all know by now). Finally, they cry more and their mothers are more likely to rate them as ‘fussy,’ ‘difficult’ or ‘colicky’ than mothers who didn’t have epidurals. If moms knew about these proven risks to their baby from an epidural, I bet we’d have a lot of unemployed anesthesiologists!
I think we just need more honesty about the fact that taking an epidural means giving your baby drugs, with all the risks that go with that. If doctors told moms this, then it would take no time at all for us to return to the way things used to be: women with exceptionally difficult labors would have medical pain relief as truly needed. The rest of us would give birth without drugs, supported by experienced older women who also made it through birth without drugs and can reassure us that we ARE strong enough to rise to the challenge. Now, sadly, few women even KNOW anyone who birthed without drugs. We’re seen as freaks. When really we’re just normal women … in a society that has drifted so far from normality that we’ve all forgotten how strong ordinary women really are. This would put us in line with all other developed nations, in which epidurals are treated as the powerful drugs they are and reserved for cases where they’re truly necessary.
Sadly, this seems unlikely. But in the meantime the best we can do is put word out to other women about the risks so they can make informed decisions.
Thank you for your well thought out comment. It is true, if moms were educated about the effects of epidurals on their babies, they would be motivated to research their options!