Insurance Companies Rejecting Women With History Of Cesarean

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.