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 Maternity Wars
Europe's moms-to-be are demanding greater control over the way they give birth. |
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Hail Caesar
How many C-sections are really necessary? |
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Posted Sunday, March 7, 2004; 14.48GMT
A close look at the data suggests that lifestyle C-sections remain rare. Three-fifths of U.K. caesareans are emergencies, occurring because labor is failing to progress or the baby is in distress. The remaining two-fifths are classified as elective C-sections, meaning those performed before the onset of labor, usually for a medical reason. Elective C-sections are clearly on the rise — in Britain in 2002, they accounted for about 9.3% of all births, up from 5.5% 10 years earlier. But many are scheduled by women who have had one emergency C-section and know they are likely to need another; in the U.K. in 2001, 67% of birthing women who'd had a C-section repeated the procedure. Maternal-choice C-sections — those without any clear medical reason — account for only about 1.5% of births in the U.K.'s public hospitals and 1.6% of all U.K. births. And doctors say most of those are not motivated by convenience or lifestyle factors; fear of labor plays a much stronger role. Says Robert Verwey, consultant obstetrician and gynecologist at Bronovo Hospital in the Hague: "Any sensible human being would do anything in their power to avoid hours of serious pain."
In the U.S., according to Health Grades, a company that evaluates the quality of health care, the number of maternal-choice C-sections jumped 20% between 1999 and 2001, when they accounted for just under 2% of the country's 4 million births. Samantha Collier, Health Grades' vice president of medical affairs, says that as long as the woman has been fully informed of all the risks "the ethic now is that mom is autonomous."
That's fine when mom is footing the bill, but even private insurers are balking at paying for C-sections. In 2002 AXA PPP Healthcare, a private U.K. provider, said it would no longer cover even emergency C-sections. Says David Costain, the company's medical
director: "The number of C-sections we were being asked to pay for was rising so rapidly, and it showed no signs of leveling off. It just wasn't plausible that they were all medically necessary."
Who gets to decide? It's a question that experts everywhere are grappling with. In Europe, women dependent on state health care will necessarily have their choices limited. And if private insurance continues to clamp down, it may be only the wealthy who have total choice. In the U.K.'s Portland Hospital, among the best-known of the country's small number of private clinics, the maternal-choice C-section rate is about 15% — 10 times the number in the public system. At the Portland, smiling men in claret-colored waistcoats greet you at the entrance and take your bags. And when the time arrives, smiling medical personnel help you deliver your baby. As many as 2,100 women annually come to have their babies at the Portland — among them Beckham and actress Hurley.
American actress Gwyneth Paltrow, 30, was rumored to be considering the Portland for the birth of her first child with British rocker Chris Martin. British newspapers have been obsessively tracking Paltrow's choices — a prenatal yoga regime, birthing pools reportedly installed in her homes in London and the U.S. In the end, she is said to have opted for London's other celebrity hospital, St. John and St. Elizabeth, where model Kate Moss had her baby.
These private clinics are a far cry from the busy wards of Britain's public hospitals, but they come at a price. For a regular vaginal delivery at the Portland, patients can expect a bill for $4,340 for the birth and the first night, $1,712 per night thereafter. The Portland offers package deals for non-medical C-sections: $7,973 for the first night and the operation, $2,114 for subsequent nights, including medication. Most C-section patients stay five days, at a total cost of $14,315.
At 8 a.m. this Friday, 34-year-old freelance consultant Betsy Ludwig is scheduled to have her baby at the Portland by maternal-choice C-section. As she's an American expatriate, the cost will be covered by her insurance, but that's not the the reason why she chose the Portland. Instead, she wanted maternal choice there because she considers it the lowest-risk way to give birth. "Pretty much every woman I know who is my age or above has had to have an emergency C-section," says Ludwig. "Why go through all of that if you don't have to?"
In Germany, private insurance offers other options, too. Ruth Wishart, a 40-year-old Scottish woman who has lived in Berlin since 1999, started thinking about having a child two years ago. She decided she wanted to have a natural birth, so she opted for the Birth Center Klausenerplatz, which doesn't provide medical intervention. Since 1997, the number of such organic birth facilities in Germany has doubled, although only 2% of women actually give birth outside the hospital system. In the lead-up to the birth of Wishart's son, Ben — now three months old — she met with the center's midwives, who monitored Ben's position and his size. When her due date came and went, the midwives suggested that she drink first herbal tea, and later, a mixture of castor oil, vodka and orange juice. After just two slugs of that, she went into labor. In the center, she stayed in the birth tub for a couple of hours. Then she moved to the rope, and later the large birthing ball — both of which help the muscles relax. The pushing stage lasted an unusually and agonizingly long four hours, but soon after Ben emerged, she was sitting, sipping champagne. The midwives "absolutely knew what they were doing," she says. "They managed to get strength out of me that I did not know I had. In hospital they would probably have used forceps." The centers are proving so popular that soon they may be covered by the state-sponsored insurance scheme. That kind of progress suggests that European women are destined to win the battle for control of their births. But it certainly is a slow, painful delivery.
With reporting by Lauren Comiteau/Amsterdam, Mimi Murphy/Rome, Grant Rosenberg/Paris and Regine Wosnitza/Berlin
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