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Saturday, March 13, 2010

Americans - even President Obama - getting "too much" care

Experts are suggesting that perhaps Americans are getting over-treated : "too much cancer screening, too many heart tests, too many cesarean sections." Recently a study found that angiograms are being overused, and even the President has gone through a battery of tests lately that some feel are unnecessary and extensive for no real reason.

I was excited, if for a brief shining moment, that the article mentioned "too many c-sections," and in one article I read the recent NIH conference on VBAC managed to register a blip on their radar screen. It gave me hope. But none of this is "news" to countless pregnant women who feel they've been tampered with, prodded and poked endlessly, often for no good reason.

Some tests, like cancer screenings, I'm all for, though, especially when you consider that Americans generally have a better prognosis and survival rate for certain cancers like prostate - because we generally treat it more aggressively than some of our European counterparts. Of course, I can't find the article I read several years ago in the Wall Street Journal, but it basically suggested that in some countries more males were dying of prostate cancer - a generally slow-spreading disease - than they were in the US, because of their less-aggressive approach to treating the illness.

Maybe this latest revelation is good news for pregnant women, but maybe not. It might bring to light that medicine in general is overwrought with waste and needless intervention across the board, and no where does it seem to be the case than in maternity care. If it can somehow change opinions that "it's best for the baby" when, in fact, it might not be, then we might be getting somewhere in educating others of our plight.

The most recent push for a national healthcare plan has had me wondering how all this is going to sort itself out for some Americans, or if it will make it worse. What does it mean for the pregnant woman? Generally speaking, we know that a more low-tech approach to prenatal care and labor can, in the low-risk woman, have better results, both in the short and long run. Fewer interventions means mom's labor can actually be shorter, less painful, and that she'll likely have a better recovery.

But how do you re-train doctors to this way of thinking? Will they revert to unsafe practices to avoid being punished by a government-run healthcare scheme for wasting too much money? I've often thought that some private insurance carriers should investigate OB's with a high rate of induction, episiotomy and c-section, as these are all procedures that cost the insurance company more money because it means more drugs and more care. When I compare the insurance bill I received after my VBAC delivery with no epidural and the one I received from just the anesthesiologist after my third was born, I realized the spinal block for my section alone cost almost as much as my entire vaginal birth.

If I were a pregnant woman using national healthcare, I'm not sure how I would feel being seen as a means to save the government money. But neither do I appreciate being seen as a cash cow by an OB. And if it means I could have a healthy, low-tech birth without you sticking your fingers in my vagina every 10 minutes, then I guess I'm all for it.

I wonder if, in a way to save money, the government would encourage OBs to avoid c-sections unless absolutely necessary. Would they again start teaching OBs how to deliver breech babies? Restrict the use and administration of Pitocin (which, according to manufacturer guidelines, they should be doing already)? Or does it mean doctors will continue to induce, but go back to using the less expensive Cytotec instead? Would the government condone its use because it's cheaper, ignoring the risks that Searle has outlined and put women at even more risk? From what I've read some OBs disagree with Searle's warning and are using it anyway, or are pissed off and think it's bunk.

My biggest fear is that OB's would be forced to return to a care model that they are, by and large, out of touch with. Does it mean that doctor who's been in practice for 30 years, in the last 15 of which he's never delivered a breech baby vaginally, is now suddenly being asked to deliver that baby? Maybe more women would choose midwives, who are usually more equipped to handle low-tech births, and then there would be even more midwife backlash from OBs than there is already. Maybe OBs would feel that their hands were tied, and as a result, just recommend to a government payor that cesareans are the safest way for every mother.

We know that some countries with national healthcare, like The Netherlands and Great Britain, have great success with low-tech, low intervention births. As a way to save the government money, they encourage home births and VBACs. But if you take a physician who does not practice this model of care, hasn't in years, and doesn't plan to in the future, what outcome can we expect for pregnant women?