Sweat poured from her brow with each superhuman effort to push out the large baby through the birth canal. But, after 2-1/2 hours of “One more push, Crystal! You can do it!,” the hope of a normal vaginal birth slipped away. It was hard to calm the tremble in my own voice that delivered the news: “It’s not progressing, Crystal. The only way your baby boy can come out is by cesarean.”
Now, her sweat mingled with her tears and those of her husband. The Rodriguez couple had done everything right: They had postponed pregnancy until their mid-20s. They had adjusted their income, their careers, their household, their diet, and their attitude in preparation for this baby. She had sought my advice before conceiving and sought prenatal care by the second month of pregnancy. She had eaten well and carefully limited her weight gain. But this picture-perfect pregnancy was ending in cesarean because of “failure to progress,” the common situation where a baby’s head is too big for the mother’s birth canal. It is the most common reason for cesarean birth.
In the operating room, Crystal — under epidural anesthesia and with her husband at her side — chatted nervously until doctors pulled a screaming baby from her tummy. We all cried with joy. All was well.
But Golden Rule Insurance now says that Crystal has a “disease” called “previous cesarean,” and she is now uninsurable.
We Colorado physicians who deliver babies continue to do so because we are skilled, love being part of each new family and cherish watching kids grow up without having to feed them from our own refrigerators. We physicians intimately know each pregnant woman, expectant father and proud family. We focus on giving birth to the healthiest, smartest, most beautiful child ever. None of us are thinking of financial downside of a truly life-saving cesarean birth.
Over my several weeks each year of giving medical care in rural Honduras, I have seen an entire community mourn the death of a pregnant woman known only as “Juan Carlos’ mother.” Juan Carlos, now age 20, is one of the most respected citizens of San Marcos, Honduras. He has been motherless since age 2, when his mother died in labor en route to a hospital many hours distant. Eighteen years later, that rural community is still haunted by the loss. Now, in 2008, young women not born at the time of the tragedy, ask if they will suffer the same horrible childbirth death as “Juan Carlos’ mother.” A hundred years ago here in Colorado, Crystal would have had no choice but to labor much longer until, like “Juan Carlos’ mother,” she and her baby died.
Today, every American should have health insurance to protect against such disasters. But now the insurance industry is failing us by calling motherhood an uninsurable disease. Throughout history, the role of giving birth to and raising children has been the most honored position in society: No one but mothers can perpetuate the human race. Now Golden Rule Insurance finds motherhood to be a focus of financial loss and a disease to be shunned. We have the skill, the tools, the drugs, and the money to perform safe cesarean births. But some women, fearing the stigma of cesarean, may refuse surgery and persist in labor longer than is safe for herself and her baby.
I ask of the medical director of Golden Rule Insurance, United Health Care, PacifiCare, Anthem and all other insurers: What should we do for you, for your wife and for your mother in her third exhausted hour of pushing vainly through labor? Should I say, “Come on, Mrs. Golden Rule Executive, you can do it! Just give me one more push!” Or should we move to the operating room and deliver a healthy baby?
Warren Johnson (tecolote@earthlink.net) is a triathlete and family physician in Brighton. EDITOR’S NOTE: This is an online-only Colorado Voices column.
