Friday, February 1, 2013


Because of my concern about decreased fetal movement (and we're talking about from 40+ kicks in an hour to 10-15, so still above the minimum) I got to go be hooked up to the machine that goes PING! for an hour to have a non-stress test.  It was super, and by super I mean it was mildly uncomfortable and took a long time (an hour and a half total with waiting around for lab work).

Today I got to think about the abundance of caution versus high costs of healthcare while I was laying around pretending to be interested in the TV.  Technically did I really need that NST?  No.  How about that repeat blood work verifying I don't have any diseases Little Monster can catch?  Decidedly not since I had that whole panel done in pregnancy 4, less than 15 months ago, and have had zero new sex partners since then (shocking, I know. Monogamy in all its glory.) so two other docs have opted not to run this panel.  Why did this doc decide to run it? Because if my results aren't on file, some well-meaning pediatrician will run all these tests on Little Monster once zie is born, and nobody wants a baby having to have a huge number of blood draws.  Why did I decide to go with it? Because it won't cost me anything to have it done, so why not avoid having to opt out of it later?

If I had a midwife and not an OB?  Probably wouldn't have had the NST just yet, just maybe a sooner follow-up visit.  I stumbled into a press release from the American College of Nurse-Midwives about a study showing that women who deliver in nurse-midwife-run birthing centers rather than hospitals have a much lower c-section rate, and I am unsurprised.  I've had 2 visits with anesthesiologists to make sure I have a good airway in case I need rapid intubation for an emergency c-section (and this is probably good to check) but has also included chatting about epidurals and how early in labor I can get one, along with other pain management options (aka drugs).

This is not to say that anyone has been unsupportive when I point out that I'm not planning to have any drugs at all.  Both anesthesiologists were very friendly and not pushy at all about pain meds, but at the same time, nowhere else in this healthcare system is anyone talking about other ways to manage pain (aka various labor positions and self-hypnosis), and certainly not for 30 minutes with no interruptions.  Man, if everyone delivering at this hospital got 30 minutes of undivided, attentive care from even a nurse on pain management outside of drugs... what a world...

The other really interesting item from the Nurse-Midwives' website was about a study on malpractice insurance costs (aka Why Babies Cost So Much and Why We Must Intervene Or ELSE!) that found malpractice claims were not higher than other areas of medicine.  Let me say that again.  No higher malpractice claims were found in OB than other areas of medicine, so there are actually not any higher costs associated with being an OB than another sort of doctor.  It also found that mothers tended to be claiming malpractice as a result of substandard care (in fact, all this "prevent harm to babies AT ALL COSTS" stuff isn't impacting 3/4 of the malpractice claims that involve mothers getting bad care). Hmm.

One of the things that gets my goat is how much we perceive pregnant women as vessels for the unborn rather than people. You see it in the way we treat mothers with strolling-around-children as well. Babies first, mothers are some sort of second thought because they exist to care for babies and nothing else. It irritates me to no end. Being a person is important, and while I'm also growing an additional person, I remain a person with rights, needs, and interests unrelated to gestating.

I get why we like to pinch pennies from this realm of healthcare.  It's a lot easier to say, "We could save 50% on a delivery that isn't a c-section! Let's avoid them!" rather than to say "nobody over 75 should have a bone density scan because the cost is high and the benefit of knowing how severe osteoporosis is is minimal" or "nobody over 80 gets chemo unless they pay out of pocket for it."  There are clear downsides too to an excess of care in a fundamentally healthy person, and there are theoretical upsides to testing and treating very old people.  BUT if we consider where all this money that doesn't make Americans healthier is going in our "healthcare system," it is not mostly going to unneeded c-sections.  Most of the "waste" in the system is medications we aren't taking (and either people getting sick because they should have, or tossing them out after they are paid for by insurance) and end-of-life care that many people don't want but get because either they don't realize they could opt out or their family isn't ready to let them die just yet.

Knowing that I let my personal nerves go along with my doctor's quick fix for making sure everything is all right, I get it.  It's nice to know everything is fine.  It's nice for my doctor to have evidence that everything is fine.  It's nice to know the twinging is actually contractions and I might need to pay some attention to it.  But at what cost? Would I have been just as happy with a reassurance that since Little Monster's kick counts are still regularly above the minimum, things are very likely totally fine, and keep at the kick counts and come in if they decrease? Probably.  Healthcare dollars saved! Relationship built!

On the whole, though, I'm hoping to avoid anymore scenarios involving the machines that go PING! and aren't telling us anything valuable beyond that the machine is really good at going PING!  After the next NST scheduled for Tuesday of course...

No comments:

Post a Comment