How Insurers are Still Pulling Maternity Coverage from Pregnant Women’s Plans

by Melissa Garvey, ACNM Writer and Editor

As of 2014, maternity care coverage in the United States will take a step up. Under the Patient Protection and Affordable Care Act of 2010, health insurance plans will no longer be able to turn away applicants based on the “preexisting condition” of pregnancy. Maternity care coverage will also be mandatory for individual and small-group insurance plans as well as policies sold through state-based insurance exchanges. This is good news.

But until 2014, women will continue to get pregnant. About half will become pregnant unexpectedly and may have the added stress of no maternity care coverage. Plus, more women will try to conceive and discover in the second, maybe even the third trimester, that their maternity benefits have been cut considerably or have become significantly more expensive.

That’s exactly what happened to The Feminist Breeder—a blogger and birth advocate planning a home birth with a certified nurse-midwife under the coverage of Blue Cross Blue Shield. Here’s what happened to her after months of planning to conceive her third child:

…we found out that coverage we signed up for last year isn’t the coverage we actually have now because they keep decreasing it every year, and it’s going to get even worse in 2011. Starting in January, almost NONE of our homebirth expenses will be covered because of a massive deductible increase, and what is covered will cost us a ton more than we anticipated when we made the decision to start trying to conceive last January.

Even more women are blindsided by expenses they never knew to expect. My cousin is staring down the barrel of inflated health care bills because her maternity care will stretch across two calendar years, two deductibles, and two out-of-pocket costs. A recent Washington Post article features a woman paying $400 per month for an individual health plan who thought “it must be a mistake” when she discovered her plan required a special maternity rider in advance of the pregnancy in order to be eligible for childbirth-related coverage.

Where does this leave mothers until 2014? It doesn’t look good.

Access to Midwifery Care Improves Maternity Outcomes

by Tina Johnson, CNM, MS, ACNM Director of Professional Practice & Health Policy

The Patient Protection and Affordable Care Act will bring millions of newly insured citizens into the health care system. In order to meet the country’s needs, leaders are calling for high value, evidence-based solutions. Let’s start with the health condition that affects 100% of all Americans...childbirth! How can we provide high quality, high value maternity care for all women and families? The answers are in the evidence: midwifery care improves maternal and newborn outcomes and patient satisfaction, reduces health disparities, and saves money and resources.

The U.S. grossly outspends every other nation per capita on health care, yet our maternal and newborn outcomes lag far behind those of other developed nations. Childbirth is the number one reason for hospitalization, and its related hospital charges surpass those of any other health condition. Resource-intensive interventions like labor induction, epidural analgesia and cesarean section are overused, often without indication or consideration of alternatives, resulting in increased risk of maternal and newborn harm.

Cesarean section is the single most common operating room procedure in the U.S., and the rate is steadily climbing. Incredibly, in 2007, nearly one-third of American women delivered their babies by cesarean section. Maternal mortality has risen dramatically, and glaring racial disparities in maternal and neonatal outcomes persist.

How can we reverse these disturbing trends? Ensure that all women have access to maternity care providers and practices that support the normal processes of birth. Labor support, freedom of movement, intermittent monitoring, alternative birth settings, vaginal birth after cesarean...all have been identified as evidence-based practices that are underused.

Midwives truly are the experts in supporting healthy vaginal birth in all settings. Midwives caring for low-risk women improve infant mortality rates in both hospitals and birth centers when compared with physicians caring for equally low-risk women. Midwife-led models of group prenatal care reduce preterm and low birthweight rates and improve patient satisfaction. Birth centers provide improved outcomes for even the most at-risk women, reducing preterm birth, low birthweight and cesarean section rates, and reducing costs to our health care system. Skilled midwifery care is the gold standard among nations with the best maternal and neonatal outcomes, and has been identified as essential to reducing maternal mortality worldwide.

It’s time to bring that message back home. The time is now to promote and support midwifery in America—and to follow the evidence.

This post was originally published on the the Center to Champion Nursing in America (CCNA) blog. Visit CCNA to join more conversation about this post.

Quality of US Maternity Care on Track to Improve With or Without Legislation

by Melissa Garvey, ACNM Writer and Editor

As you may have already heard from ACNM Federal Lobbyist Patrick Cooney, health reform legislation has reached a startling, disappointing halt. We are not sure what this means for the numerous provisions that would increase access to midwifery and birth centers.

In the face of this development, I’d like to take time out to raise everyone’s spirits and highlight a few exciting initiatives that are moving full steam ahead, whether or not health reform legislation passes soon. Each initiative has the same mission as many of the Senate’s proposed health reform provisions: to improve the quality of maternity care for US women.

1. The March of Dimes released a webcast edition of its Symposium on Quality Improvement to Prevent Prematurity, which ACNM cosponsored last October. Registration is free and gives you access to information from expert speakers, including ACNM President Melissa Avery and A.C.N.M. Foundation Secretary Nancy Jo Reedy.
   
   
2. This week, the Joint Commission issued an alert on preventing maternal deaths during and after pregnancy. The alert points out that maternal mortality rates in the United States are not declining, and may be on the rise. Even more disturbing is that for every mother who dies from pregnancy-related causes, 50 more mothers will become very ill due to significant problems during pregnancy, labor, and delivery. This isn’t good news, but it does promote awareness and proposes steps toward improvement. Lamaze International has taken this opportunity to issue its own set of recommendations for preventing maternal deaths.
   
   
3. Childbirth Connection has released findings from its 2009 Transforming Maternity Care Symposium. This was a major effort by numerous stakeholders in US maternity care, including ACNM, the American College of Obstetricians and Gynecologists (ACOG), and the Midwives Alliance of North America (MANA), with the purpose of transforming US maternity care into a wellness, woman-centered model. Their vision document, blueprint for action, and more are now available. I suspect midwife Amy Romano, CNM, will weigh in with more commentary at Science and Sensibility soon.
   

These are just three initiatives among many in progress toward improving the quality of US maternity care. What other initiatives and projects are you keeping an eye on or participating in?