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For Immediate Release

Insurance Companies Rejecting Women with History of Cesarean

Some Companies Require Surgical Sterilization for Coverage;

Trend Gives New Imperative to Learn Ways to Avoid Unnecessary Cesarean

Redondo Beach, CA, June 1, 2008 – As reported in today's New York Times, ICAN has begun tracking an alarming new trend of insurance companies refusing to provide health insurance for women with a history of cesarean surgery. In some cases, women are being rejected for coverage outright and in other case they are being charged significantly higher rates to obtain the same coverage as women without a history of cesarean. With over a million women each year undergoing this surgery, this practice has the potential to render large numbers of women uninsurable.

This trend surfaces as the rate of cesarean surgery, including unnecessary cesareans, continues to rise. In 1970, the cesarean rate was 5%. In 2007, it was 30.1%. Experts often cite the incentives within the health care system for driving up the rate of cesarean unnecessarily, including physicians' medical malpractice fears, better reimbursement for surgery, and lifestyle conveniences for care providers and staffing efficiencies in having more "9-5" deliveries.

"Women are caught in the middle of a dysfunctional system. Doctors are telling them they need surgery, even when they don't, and insurance companies, who are tired of paying the bill for so many frivolous surgeries, are punishing women for the poor medical care of doctors," said Pam Udy, President of the International Cesarean Awareness Network (ICAN).

The trend is highlighted in the cases of women like Peggy Robertson of Colorado. When she applied for health insurance coverage with Golden Rule, her husband and her children were accepted, but her application was denied. After multiple inquiries directed to the insurance company, she was finally told that she was denied because she had delivered one of her children by cesarean. "It was shocking. I assumed that as a woman in good health I would be readily accepted," said Robertson. "When I finally found someone who would explain why my application was denied, they had the audacity to ask me if I had been sterilized, stating that this was the only way I could get insurance coverage with them."

As the incidence of cesarean increases, the evidence of the downstream medical complications for women and babies, and the associated medical costs, becomes increasingly apparent. Risks of cesarean in later pregnancies include increased incidence of infertility, miscarriage, fetal deformities, overgrowth of scar tissue leading to bowel problems, and potentially deadly placental abnormalities in subsequent pregnancies.

And though most women with a prior cesarean are being encouraged and often coerced into having repeat cesareans by their doctors and hospitals that have banned vaginal birth after cesarean (VBAC), a pair of recent studies done by the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network demonstrates that women who deliver vaginally after a cesarean fare significantly better than women who deliver by repeat cesarean. (Obstetrics & Gynecology 2008;111:285- 291, Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery, Mercer et al, and Obstetrics & Gynecology 2006;107:1226- 1232 Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Silver et al.)

"Most women are looking to avoid cesareans. But physicians often make surgery difficult to avoid by insisting on non-evidence based practices," said Udy. Practices that fail to improve the outcomes for mothers and babies and increase the risk of cesarean section include inducing for going post-dates, inducing for suspected large baby, requiring fasting during labor, requiring women to be confined to bed for continuous fetal monitoring, and failing to offer continuous support to a mother in labor. "These care practices serve the system well, but not mothers and babies" Udy added.

In fact, women and their babies may be paying a higher price than being denied health insurance. Last August, the Centers for Disease Control reported that, for the first time in decades, the number of women dying in childbirth has increased. http://www.cdc. gov/nchs/ data/nvsr/ nvsr55/nvsr55_ 19.pdf Experts note that the increase may be due to better reporting of deaths but that it coincides with dramatically increased use of cesarean. The latest national data on infant mortality rates in the United States also show an increase in 2005 and no improvement since 2000. http://www.cdc. gov/nchs/ products/ pubs/pubd/ hestats/prelimde aths05/prelimdea ths05.htm Internationally, the U.S. ranks 41st in maternal deaths and has the second worst newborn death rate among industrialized nations.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online. org for more information. In addition to more than 90 local chapters nationwide, the group hosts an active on-line discussion group that serves as a resource for mothers.

Women who want to reach their lawmakers can visit http://www.votesmar  Women who want to reach their state insurance commissioner can visit http://www.naic. org/state_ web_map.htm .

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://www.ican- resources/ white_papers/ index.html

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

Contact: Gretchen Humphries (734) 323-8220




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Jun. 2, 2008 at 10:59 AM Voted popular. everyone should read this!

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Jun. 2, 2008 at 2:42 PM That is crazy!

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Jun. 2, 2008 at 2:45 PM that plain sux

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Jun. 2, 2008 at 3:51 PM I can understand the insurance companies wanting to contain costs....I was staggered at the difference between the cost for my son's birth and my daughter's birth (both natural, but 12 years apart and pretty routine stuff)  The idea of sterilizing people is just insane, but be careful, because under socialized medicine and the banner of giving free health insurance to all-don't be surprised if that is exactly what occurs in the name of making health care affordable for everyone.   They are testing the waters here, to see how far they can go....I can envision a day when children suspected of disability would become disposable and an insurance company would pay for the abortion, but not for the birth of a child who is not entirely perfect.  It isn't just this issue, but how much power are we to allow the insurance companies, or in the event of national health coverage, in our personal, health  related lives?

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Jun. 2, 2008 at 11:27 PM I am infuriated by this article. I am a woman that can only have children by cesarean. My pelvis is does not separate to allow for the babies to get through. My first born was an emergency because he was stuck for 3 hrs while I tried with everything I had to push him through......he was stuck to the point that they had to pull him out of my birth canal before they could deliver him through my incision. So, because I was born in a way that is not readily easy to just pop out the kid and walk out of the hospital, my right to have them should be denied!?  I should be "sterilized"??? Oh  but no. SO, I have no say over my own body and what I am willing to go through for my family?? Most women take into consideration every aspect of having a baby. Everyone who gets pregnant has the chance that they might have to have surgery. Those of us who want large families should have our hopes dashed because some moron in a suit wants to save some $$$$??? I have never had the option of what I wanted to do as far as where I wanted togive birth, do I want a midwife or obgyn, do I want a homebirth or a birthing center, water or bed.......ALL of those options are null and void for me....and not by my choice. But, I have the choice to go ahead and have more children (as long as I am healthy enough to do so) and NOONE is going to tell me that I need to be sterilized.

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Jun. 3, 2008 at 12:16 AM I agree w/ you halfadozenofem.  I feel those of us (me too) that HAVE to have c-sections are being punnished because some doctors would rather do it for those that don't need one.  I am in school to become a doula and that is one of the reasons for it.  I want to be able to help mothers be able to make their own decision about their birth not have the doctor choose the form of birth for them.  Though I know there are circumstances for a section.  I was one of those who ended up w/ 2 emergency c-sections.  I just wanted for the record to state that I do not agree w/ this article!!!  It really upset me and that is why I posted it. 

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Jun. 3, 2008 at 12:35 AM I wanted you to know that I was not fussing at you, lilmommie00.....I was fussing in general. I thank you for posting this............I read the article to my DH and he looked at me when I was done and said, "I think I'll sleep all the way on the other side of the bed tonight!" lol....b/c I was so mad!!! But, seriously........What are we? dogs? cats? To be told that we need to be sterilized......that still has me spitting mad!!! My children are worth whatever means to get here, ya know. My family is no less important because of how they are born.

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Jun. 3, 2008 at 2:40 AM This is very unfortunate for the 3-5% of womem who need c-sections, but maybe just maybe it will help to wake up the other 30% of women doctors put under the knife for no reason at all. 

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Jun. 3, 2008 at 7:28 AM Isn't that discrimination and can't they get into a lot of trouble for that?  I had a c-section because one of my twins was breach and tagled in his cord.  That is outragous!!!!  I'm speachless....

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Jun. 3, 2008 at 7:57 AM I was in labor for 27 hours after my water broke.  I never got past 6 cm.  We HAD to do a c-section because the baby was at risk of losing all amniotic fluid.  He was in a transverse position wtih his head pressed against my uterine wall.  If we didn't do a c-section he would not come out, and he would have died.  These f-ing insurance companies have gone too far.  Considering how much money they rake in one would expect them to supply coverage as needed, not as their greedy little minds think it should be provided.  And forced sterilization????  WTF is this...China???  Well, in that case, my vote goes for castration for the idiot MALE members of the insurance companies who came up wtih this stupid idea.  That way, they would never have to worry about their wives having a c-section!!!  Ugh.  I'm with you halfadozenofem!

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