We Can Make Birth Cheaper (And Better)

George was a great doula

As I’ve written about a lot this fall, America is the #1 most expensive place in the world to give birth, and yet our outcomes don’t come close to justifying our costs. If you want better outcomes at lower costs, solid bets include Sweden, Finland, and France. Within the US, taking into account “budget considerations, health care quality and the baby-friendliness of each state,” the best places to go through labor & delivery are Vermont, North Dakota, and Oregon; the worst are West Virginia, Pennsylvania (!), and Mississippi.

Still, even without dismantling our awful profit-driven health care system, there are ways that we can make birth less expensive in this country. The answer isn’t more technology. It’s much, much less. For example, as Elissa Strauss notes in Slate, through the increased, insurance-funded use of doulas, or birth attendants.

A new report from Choices in Childbirth and Childbirth Connection, a program of the National Partnership for Women & Families, argues that increased access to doulas would help drive down the cost of childbirth in the United States. Their findings show that doula care decreases the likelihood of C-sections and epidurals, which would save public and private insurers a lot of cash. According to their estimates, the reduction of C-sections alone could save Medicaid at least $646 million and private insurers around $1.73 billion annually. They go on to suggest the Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women, and that States should require private insurers to cover them as well.

Why would having yet another person in a crowded room keep labor and delivery costs down? Because doulas can help keep medical intervention to a minimum, and medical intervention is what makes birth expensive — as well as, sometimes, less safe. I know! Counterintuitive. Medical intervention saves lives, right? Absolutely. But anytime a doctor hooks up the Pitocin or talks a woman into an epidural she may not want comes with an increased risk of unnecessary surgery and the complications that can tag along with that. It can also end up making you feel as though birth was done to you, as Meaghan so memorably put it.

With these facts in mind, the UK has now officially recommended that, in nearly half of all cases, women would be better off having their babies at home. Which can be great! If you’re prepared for it. Kaiser Permanente unintentionally advised a Bay Area couple to give birth at home and the couple’s story, told on Twitter and collated with commentary by Doree Shafrir on Buzzfeed, is so suspenseful, moving, and ultimately heartwarming that afterwards you may need the equivalent of a post-coital smoke.

ahhh …

Another out-of-hospital birth story that will put a smile on your face: cops help a woman deliver on a freeway. Total nightmare but at least it ends well. Bonus: when was the last time you read a positive story about the police?

Anyway, I am all for doulas, and even more passionately for the idea of their fees — which can run as high as $2500, especially in big cities — being covered by insurance. (This site walks you through an attempt to get at least partial reimbursement for doula services. And some health insurance companies do, apparently, offer coverage.) The catch is, Strauss writes, that doulas aren’t regulated or certified. “Anyone can call themselves a doula without any training, certification, or practice. I could declare myself a doula right now. So could you.” Strauss also points out that many doulas have a “natural childbirth” agenda that a laboring woman might chafe against should she decide she wants the medical marvel that is an epidural.

To me, the answer is simple. Interview some candidates and find one with some experience and credentials whose values match yours. Talk to your health insurance company to see if some or all of that doula’s costs can be covered. Then pray you don’t end up crowning on the side of the Long Island Expressway.

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