Working Men and the Maternity Care Crisis

It would be simple to say that the problems in maternity care in this country, including high intervention rates, poor outcomes and high cost, are “women’s problems,” but it would be untrue.  Men are deeply affected by the crisis in maternity care now too.  On a personal level, as fathers, they carry the heavy burden of caring for their partners throughout pregnancy, birth, and the postpartum period.  Expectations of parental involvement in pregnancy are high now, and many men must juggle the daily demands of their jobs with medical appointments, prenatal testing, ultrasounds, which require time off during working hours and pull them away from their workplace.  Finances and job security are high on their list of concerns at the same time that they are called away to support their partner and participate in the pregnancy.  Managing childbirth classes and dealing with major life changes such as finding space in the house for the new baby, or having to purchase a bigger car or baby furnishings weigh heavy in men’s minds.  Stress is increased if their partner or newborn needs extra care, which can further affect their attendance and performance at work.  Their income is affected in the form of insurance premiums, co-pays, and deductibles when paying for care that is more expensive than it needs to be, and fosters poor outcomes that demand even more care.

The psychological effects of managing the conflicts and dealing with the additional stresses of parenthood as a working father can take a toll in terms of productivity on the job.  This can create a vicious cycle of stress reducing productivity, which further increases the stress.  This level of high anxiety can affect a man’s health, his ability to do his job, his connection to his partner, and his connection to his baby.  Extended periods like this can ultimately even effect his partner and child if it leads to illness or abuse.

Businesses that provide family friendly work environments create programs that reduce these types of conflicts and stresses.  Flex-time, telecommuting, in-house support resources including financial planning and childcare can go a long way towards making a work/family life balance achievable for working fathers.  Men who are given the tools they need to manage the demands of both work and family are happier and more productive on the job.  Businesses that strive to go the extra mile to help their employees reach that balance will find that the costs associated with these programs are offset by lower healthcare costs, less absenteeism, and a more loyal workforce.

The ultimate program that businesses can work to implement though, is a reworking of our healthcare system so that the system is more efficient, less costly, and produces better outcomes.  That would reduce everyone’s stress levels.

Downstream Business Costs of Cesarean

In last week’s post we learned that businesses could save millions of dollars by reducing the number of cesarean sections their insured employees and dependents incur in their maternity care.  What are the downstream effects of avoiding those cesareans?  Are there more savings and benefits to be had?  Why yes, as a matter of fact, there are!

Women who have spontaneous vaginal birth experience fewer infections and readmissions to the hospital for complications.  To give an idea of the costs associated with hospital readmission, a 2012 report from the Northeast Business Group on Health states that preventable readmissions cost an estimated $25 billion a year and happen frequently in commercially insured populations.  Almost twice as many women who have cesareans are readmitted to the hospital than women who have had vaginal births.

A cesarean is major abdominal surgery.  By avoiding it there is a shorter recovery time with fewer problems relating to general health, bodily pain, extreme tiredness, sleep issues, bowel issues, the ability to carry out daily activities, and ability to perform strenuous activities which are common to women recovering from C-section surgery.  Furthermore, many women who have had cesareans develop long-term health problems relating to the surgery such as adhesions, chronic pain and numbness at the incision site.  To resolve these issues, women sometimes need physical therapy or sometimes even a further surgery, which can cost between $3,000 and $16,000.  The real cost and human capital savings come later, during subsequent pregnancies, by avoiding dangerous life-threatening complications such as hemorrhage and placental abnormalities, which can be deadly for mother and baby.

Babies born via the traditional route are less likely to be admitted to the Neonatal Intensive Care Unit (NICU.)  The Childbirth Connection report “The Cost of Having a baby in the United States” shows the “total average allowed payments for newborns that required an intensive care admission were $32,595 for newborns from vaginal childbirths and $47,429 for newborns from cesarean childbirths,” and the rates for NICU admissions for babies born via cesarean were 13% vs. 6% for normal births.

By not having to recover from surgery, breastfeeding is more likely to be initiated and maintained for longer periods of time.  This leads to healthier babies with fewer allergies and asthma, less likelihood of Type 1 diabetes and obesity, and fewer cases of breast cancer and diabetes in the moms. In fact, a 2010 study in Pediatrics stated that the U.S. could save $13 billion if breastfeeding for 6 months became the norm.

Better emotional health can be a result of avoiding an unexpected cesarean.  Women who have cesareans are more likely to suffer from postpartum depression, and that can have a serious effect on their ability to be focused and productive when they return to work.

Keeping all these numbers in mind, doesn’t it seem worthwhile to actively seek out opportunities in your workplace where you can steer the people you insure away from costly, unnecessary surgery?

The Corporate Cut

How many cesarean sections does your corporate insurance plan pay for in a year?  If you work in an industry unrelated to maternity care, you may not think to ask this question – but you should.  Why?  Because the current cesarean rate in the U.S. today is over 30%, even though the World Health Organization estimates that 15% is the optimal rate for balancing the risks of this major surgery against the benefits. If your business were to achieve half the national rate (i.e. the optimal rate of 15%) it could save your company thousands, if not millions of dollars a year.

“The Cost of Having a Baby in the United States,” a recent report released in January 2013 by Childbirth Connection, states that maternity costs in the US have risen by 50% since 2004 and the “average total Commercial insurer payments for all maternal and newborn care with vaginal and cesarean childbirths were $18,329 and $27,866, respectively.”    By avoiding one employee’s cesarean section a year a small company could save more than $9,500.  Ten cesareans avoided saves $95,000, and 100 unnecessary cesareans averted by a corporation that currently pays for 350 births annually saves almost one million dollars in a year.

You may be thinking that cesarean surgery is necessary to save the lives of either the mothers or the babies who experience this type of birth.  It is true that cesarean, also called C-section, is a life-saving technique.  However, they are considered by many experts to be overused.  Our nation’s rising maternal death rates, which already put us at the bottom of the barrel compared with other industrialized nations, show that our high rate of C-section is not providing the lifesaving outcomes we desire from such a costly intervention.

Furthermore, a recent study released by the American Academy of Birth Centers shows that ”women who receive care at midwife-led birth centers incur lower medical costs and are less likely to have cesarean birth compared to women who give birth at hospitals.”  In fact, the cesarean rates for women transferred to hospitals from birth centers was 6%.  This shows that is possible for our maternity care system to do better.

Reforming our maternity care system is a David vs. Goliath fight.  Reform-minded underdogs such as midwives and consumer advocates who are armed with scientific and qualitative evidence and cost-saving practices are coming up against well-funded entrenched stakeholders like hospitals, medical societies, and insurance companies that are fighting to keep the status-quo to protect their bottom line.  Savvy businesses will recognize that because they are commercial insurers of their employees they already have a horse in this race.  It is time for corporations to learn about maternity care, the same way they have about other wellness issues and chronic illness control for their employees, to help bring about changes that will improve outcomes and save lives, and also save our nation billions of healthcare dollars in the process.

The first step for businesses to take to ensure they can realize cost savings in maternity care is to flex their economic muscles and let insurers, hospitals, and medical societies know that lowering the cesarean rate is a priority for your business.  Purchases of insurance products, benefits, and wellness packages should reflect that priority.  If the adequate products don’t yet exist, corporations can demand that they be created.  Healthcare improvement collaboratives can help smaller businesses leverage their power to demand these types of products.  Corporate gifts and grants to hospitals can come with the caveat that the hospital show annual progress in reducing their cesarean rates toward the 15% mark and poor results=no more money.  Push back against organizations that lobby for non-evidence-based care practices, the exclusion of birth centers, and the limiting of the practice of midwives as care providers.  Ensuring access at the state and national levels to birth centers and midwives for care will be an important pathway to economic savings in the coming years.

What can your company do to help employees reduce their chance of having a cesarean birth?

(Truven Health Analytics, Childbirth Connection, Catalyst for Payment Reform, Center for Healthcare Quality and Payment Reform, 2013)

(Susan Rutledge Stapleton CNM, 2013)

Why Corporations Should Put Midwifery Bills on Their Legislative Watch

How easily can the women you cover with your benefits packages access low-cost, low intervention maternity care?  There is a lot of discussion around the internet these days about how the use of midwives and birth centers could save the government billions of dollars because it pays for almost half the births in this country through Medicaid.  Who pays for the other half of the births in the country?  American businesses, through their employee benefits packages.  The style of care that midwives in birth centers and out-of-hospital provide is low-intervention and lower cost, is beneficial for the majority of women giving birth, most of whom are considered at low risk for problems with their pregnancies, and leads to better outcomes with less morbidity.  That’s great, but if women can’t access it, then it doesn’t lead to cost savings.  Women can’t access midwifery care if state legislation does not support it.

In order to see the cost and performance benefits of midwifery care, out-of-hospital midwifery and birth center regulations, along with payment structures, must be aligned with the goal of providing widespread access.  These state-level regulations are set through legislation.  Every state has a different set of rules dictating what type of licensure midwives must have, how birth centers must function – if they are allowed at all, and whether or not payment is required through Medicaid or Medicare and private insurance.

The ideal legislation would:

• Set clear guidelines for who may legally practice as a midwife out-of-hospital, and include all the pathways for licensure, including Certified Nurse Midwives, Certified Professional Midwives, Certified Midwives, and Licensed Midwives
• Allow midwives who practice out-of-hospital to be regulated by midwifery boards, not medical boards and have no requirement for written collaborative practice agreements with obstetricians
• Allow independent birth centers to operate unencumbered by onerous rules
• Require that all types of licensed midwives be reimbursed by Medicaid, and also private insurance
• Provide adequate funding and appropriate regulation of the educational system in order to train more midwives

26 states currently have legislation that regulates out-of-hospital midwifery.   10 states outlaw direct-entry midwifery, and 14 states have ambiguous regulations or licensure is unavailable.   82% of states have regulations regarding birth centers, and it is important to know if those regulations in your state favor them or not.  There are also regular pushes by medical trade groups, hospital organizations, and medical boards to alter legislation to favor hospital birth in order to maintain market share.  There is a lot of money at stake when it comes to maternity care, and hospitals and doctors are reluctant to allow the competition that midwifery creates in the marketplace.

If legislation doesn’t align to provide your employees with access to midwifery and birth center maternity care, your business will continue to pay top dollar.