The Baby-Friendly Hospital initiative is perfectly safe

Last week, the American Academy of Pediatrics published a clinical report that took a look at safety practices of bed-sharing and rooming in. This wasn’t a policy paper, but instead more of a “this is what a group of Pediatricians think” sort of thing. Headlines have been all over the map on this one, though. Some wise nurse and professionals looked at the publication and took away the advice that hospitals need to have good staffing levels and well-trained competent nurses to make sure patients are safe. Sorry to sound flip, but DUH. I guess there are plenty of places that put profits before patient safety (ahem), but in 10 years of attending births, I’ve only seen poor care of a baby after birth in 2-3 cases.

And then, Elisa Strauss of Slate has her opinion: The paper proves that a Baby-Friendly designation makes a hospital inherently unsafe.

Are you kidding me?

In reality, the paper does mention that aspects of the practices outlined by the Baby Friendly Hospital Initiative need additional guidance for safety– but nothing shows that these hospitals are inherently unsafe. Strauss has a history of writing about studies in a very odd way– in January she tore apart the idea of having a doula based on the most inane logic possible. If you want to see someone hell-bent on espousing experience-based practices, she’s your writer.

How dies she even come to her conclusions?

First, she writes that, “Their [the researchers] first area of concern is the initiative’s requirement for skin-to-skin contact between mother and child directly after birth until the completion of the first feeding, and to encourage skin-to-skin contact throughout the hospital stay. The problem is not the skin-to-skin contact itself, which has documented benefits, but the fact that mother and child are often left unsupervised during this time.” Immediately postpartum, nurse coverage should be 1 to 1– a nurse should have no other patients than the baby and new mother. Yes, complications can develop quickly right after birth, and medical supervision in needed. However, the problem isn’t the skin to skin contact– it’s hospitals that profit from lean staffing levels. Further, Strauss doesn’t present any solutions– does she think these babies should be taken away from the new parents and placed in a nursery with dozens of other babies with only 1 or two nurses to take care of these babies? Or should the babies be left in the warmer in the room for a couple of hours following birth? Or…..what?

The next paragraph is a doozy. Strauss writes,

Other concerns in the JAMA paper include the encouragement for rooming-in, even when the mother is exhausted or sedated. They believe this can lead to unsafe conditions for the newborn, and that parents, thinking that such sleep-arrangements were hospital-approved, may continue sleeping in such a manner once they return home. Also, they question whether supplementation with formula should really be banned, as there is no hard evidence linking early formula use to a decreased likelihood of breastfeeding further down the line. In fact, one study suggests that early formula use might help increase breastfeeding rates by reducing stress among new moms while they wait for their milk to come in.

Where to start?

NO HOSPITAL in their right minds would EVER encourage rooming in when a mother is sedated. The hospitals I have worked at rightly and explicitly disallow rooming in if a mother is unconscious and nobody else is there to attend to the baby’s needs. I want to see proof that this is a practice any place actually follows. I’m also not sure what she means by “these sleeping arrangements”. In reality, current SIDS reduction practices actually encourage parents to have babies sleep within 15 feet of the parents– in the same room. As far as formula supplementation being banned– it’s not. Nothing about Baby Friendly designation bans formula use. It calls for hospitals to pay for the formula (rather than get an unlimited free supply from the formula companies) and it calls for guidance when mothers do supplement. That’s all. This oft-repeated myth is a great tool for formula companies who want to create public panic, but it’s simply a lie. And WHY do otherwise intelligent writers perpetuate the whole nonsense that until a mother’s “milk comes in”, there’s nothing to feed a baby. It’s called colostrum, and it works very well to feed human babies and all other mammals, thankyouverymuch.

Finally, according to Strauss,

They end the paper by arguing that the Office of the Surgeon General should reconsider its call for an acceleration of the implementation of the Baby-Friendly Hospital Initiative in the United States. “If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.

The language she quoted does not exist ANYWHERE in the cited publication, and at no point do the authors even come close to encouraging the discontinuation of the 10 steps outlined as Baby-Friendly. Further, she doesn’t even include a citation for this quote, and it could be completely made up for all we know.

In reality, the authors of the AAP paper praise the 10 steps, saying, “The Ten Steps include practices that also improve patient safety and outcomes by supporting a more physiologic transition immediately after delivery; maintaining close contact between the mother and her newborn, which decreases the risk of infection and sepsis; increasing the opportunity for the development of a protective immunologic environment; decreasing stress responses by the mother and her infant; and enhancing sleep patterns in the mother.”

For better or for worse, there will always be a backlash against the movement of hospitals towards the implementation of the 10 steps of the Baby-Friendly hospital designation. However, it would serve all of us better to see this discussion happen in a place without twisting a clinical report to serve one’s preconceived editorial slant.

About that Alabama birth settlement…

Last week, a mom in Alabama was awarded $16 million by a jury to compensate her for damage; they found the hospital “violated the standard of care for labor and delivery and participated in reckless misrepresentation of fact.” Evidently, the hospital had a pattern of what the jury described as “Bait and switch”. Of note was that they hospital’s advertising touted waterbirth until At least July of 2015, even though water birth had been banned since January of 2013.

Waterbirth bans happen. In April of 2014 in response to one of the dumbest, most illogical opinions ever published in the American Journal of Obstetrics and Gynecology, Allina hospitals banned waterbirths. At the time, I blogged about the controversy, writing,

Rebecca Dekker over at Evidence Based Birth does a really good job talking about the evidence to support (or not support) the practice of allowing women to labor in a tub and to give birth in the tub. I’m not going to reinvent the wheel, so go read it on her website. The upshot? This isn’t an easy thing to study due to logistics and ethical standards, but it has been studied. It’s been studied enough that the practice is considered safe throughout much of Europe. And guess what? Their water works the same there as it does here.

So, here’s the problem: According to an archived copy of The MotherBaby Center’s (really just Abbot Northwestern, an Allina Hospital) website from June 6th, 2014, waterbirth was still an option.


Despite the fact that there was ample media coverage of the waterbirth ban, this page is, essentially, the very same bait and switch that the Alabama hospital was sued over. Waterbirth is being actively marketed, but it is not available.

This is not OK. It isn’t OK in Alabama, and it isn’t OK here.

While it’s true that Alabama ranks as one of the worst states in which to give birth in the US, with very poor outcomes for both moms and babies, cases like what this mom experienced happen all the time. As a doula, I have witnessed obstetric violence. I have been in the room as OBs told moms that if they didn’t comply, their babies would die. I have seen moms get episiotomies even though they explicitly stated that they did not consent. Some of these cases happened at hospitals that otherwise had good cesarean rates. Many of these actually happened while a patient was under the care of Nurse Midwives. Backlash from the medical community in response to last week’s verdict was severe; some doctors claimed that this verdict was not actually a victory for birthing families, but that hospitals would respond by caring even less about what her patients wanted and refusing even more obstetric choices. However, it’s important to point out that it took one mom who knew her options and knew her rights to stand up.

As expectant parents, it’s on your shoulders to take responsibility for making informed choices. Looking at a website and marketing is not making an informed choice. Staying blissfully unaware of the ins and outs of the maternity care system IS NOT assuming any responsibility for the outcome of your pregnancy and birth. You are the ones who need to ask questions. Put as much time researching your options as you spend researching cribs. Find out the difference between the different kinds of doctors and midwives that provide care. Look at freestanding birth centers. Tour hospitals and for heaven’s sake– ASK QUESTIONS. If they say they have waterbirth, ask to know the average times they use it a month. They know. If you must, tell them that you want to make sure what they market is really available.  And on the flip side, every single time something like the above happens, we need to make sure lots of people point it out and stay critical of it. Hold both marketing and maternity services to the highest standards. If nobody says anything, nothing will change.

In the MSP and surrounding communities, the voices of patients can and have produced profound change. And as much as I want to paint birth as a magical, shiny, unicorn-filled time, reality doesn’t always match that. Let’s talk about when it sucks, and when the places and people we trust create trauma, we need to raise our voices.

If you’ve seen a bait and switch in maternity care, I’d like to hear about it.



The sudden slide into depression

semi colonI’ve been pretty open about my daily life as someone who lives with anxiety. I do have enough readers and I do know that what I say has helped others reach out and feel less alone. What I haven’t been as eager to be open about is that, as long as I can remember, I’ve also had at least one depressive episode per year. It’s nothing so extreme that suicide is contemplated, but it’s definitely more than just feeling sad.

The anxiety has been a struggle this year. A big struggle. At some point last year I switched from Zoloft to Celexa. The Celexa never really did much. In retrospect, this was a terrible decision, but as I felt the creep of anxiety increasing, I was desperate to stave it off. This spring, I ended up switching to Prozac and Buspar (seriously one of the stupidest names ever). That’s when the sideways slide into depression really began.

The thing about depression is that I don’t notice it’s hit until the dark thoughts begin. Maybe this is normal, but since we don’t talk about the reality of mental health openly very often, I don’t have anything else to go off of. Someone pointed out today that we should talk about mental health the way we talk about physical health– like asthma (which I have) or allergies (which I also have); it’s a chronic condition. Most of the time these things are under control. Sometimes, the medications that I take to manage the asthma, allergies, or anxiety aren’t enough, though.

Starting in April, and through May, I was trying to help my grandmother recover from a very serious illness that needed weeks of hospital and rehabilitation center care. I mostly got through it ok, but I was without one of my teachers due to maternity leave, and some of the things about owning a business really got very seriously neglected to the point where I wasn’t capable of doing more that just showing up to teach.

It’s manageable to own a business with anxiety; the act of doing things to promote and grow and run the business become fantastic ways to soothe the nerves. If I’m doing something, I’m less anxious. It is, however, impossible to run a business once a full-blown depressive episode hits. Returning phone calls? It seemed like too much work. Reach out to providers and partners in the community? Nope, I’ll stay balled up in bed instead. Check out what others are doing to get a feel for the market? Thanks, but the mean voices in my head telling me I’m not good enough have enough fuel for their fire. And as I did less I felt more shame, inadequacy, and doubt about my ability to run a business.

Depression lies. The narrative in my head got darker as summer began. I grew desperate. I did meet with my therapist, but that didn’t help. Finally, in late June, everything came crashing down. I never got to the point of suicide being an issue, but the screening forms for anxiety and depression were startling; since I work so much with mental health through the nonprofit, seeing the scores on paper was scary.

I was so desperate to feel better. The anguish of the sadness and hopelessness grew. I’m lucky that I have wonderful friends and family did everything they could to keep me afloat. But still…

I don’t remember much from the last week of June and the first week of August. I remember feeling an overwhelming desire to check myself into a mental health unit and be hospitalized, but I also rationally knew that beds are very hard to find, and going through the hell of finding a place to be didn’t sound appealing. Again, if it was an asthma flare up, the steps would be obvious; if I got to the point of not being able to breathe, I’d go to the ED. There would be plenty of beds I could stay in while I got the meds I needed to be able to breathe. This simply is not an option during depression or anxiety flare ups.

This is what’s so bleeping frustrating about our system: while the barriers to care have slightly improved, as has been studied over and over, it’s still hard for anyone to get access to mental health for people with more minor challenges; for someone is crisis, a helpline isn’t enough. The mental health infrastructure just does not exist. We essentially have a two-lane road made of a mishmash of bricks, asphalt, concrete, and gravel that really needs to be upgraded to an eight-lane highway. Politicians like to talk a lot about “improving mental health”, but money isn’t going into building the clinics and hospitals and coverage and creating easy access to the mental health care providers that families need when they reach a point of desperation.

I am getting better. I am better. I went back on my old-old meds, and they finally kicked in July 10th. Yes I remember that day because I needed to make sure I placed my marker back into the passage of time rather than just float through the days and months as I had before.  The fog is still lifting, but I am finally getting back into the groove of life, or parenting, of running BabyLove and the non-profit. I’m getting there. I had so many friends and family, especially my husband, who held out their hands so that I had something to hold onto until I had the strength to hold on myself. I have anxiety and depression, but that’s not all who I am, and if you’re in the same place I am, it is not all who you are, either. My value, your value, is still there. We’re still here. Let’s stay here and help each other get through this thing called life.

Finally, if you are reading this an need help, you can find local and national resources over on NAMI Minnesota’s website. More work is needed to fund these community mental health response teams, though. We need more funding, more training in our state and in the US to make sure it’s as easy to get the right care for severe depression, anxiety, or other mental health concerns as it would be to get help for an asthma attack.



Free Car Seats at BabyLove


Even before I opened BabyLove, I worked at a local hospital, and one of the things I would do is teach many of the classes we held for people who were on UCare or MHP. They both had car seat programs where members on PMAPs through the State of MN could get car seats.

Fast forward to now.

I haven’t ever advertised it, but I am a contracted provider for people on HealthPartners PMAPs and MN Care to provide both car seat education and a free car seat in my office by appointment.

What, free car seat? Yep!

Women on a HealthPartners PMAP or MN Care plan who are at least 6 months pregnant and children on HealthPartners PMAP or MN Care plan from ages 0 to 8 are eligible to get one car seat during their lifetime as a member benefit. To get a car seat, either the pregnant person or the parent of an eligible child (I’ve never had a child call for himself, but I guess it could happen) calls me to schedule an appointment. The easiest availability is during the day, but I do have some limited evening appointments available. An appointment takes about 45 minutes. During the appointment, they are taught how to correctly install and use their car seat, both by video and hands-on demonstration. Unfortunately, I do not actually install the seat. When we’re done, they leave with the car seat or seats in hand.

Easy peasy!

So tell your friends, family, strangers…..if they have a HealthPartners PMAP or MN Care plan and fall into one of the two groups above….we can get them a seat! Just call me, Veronica, at 651-200-3343 to schedule an appointment.

That’s all for today, folks!




Guest Post: Every Woman Can

every woman can

Health Foundations is thrilled to announce our upcoming special event this December 9th, 2016, EVERY WOMAN CAN. This night of community, celebration, empowerment, great music and honored speakers will take place at Aria and will feature keynote speakers, Ricki Lake and Abby Epstein and the musical stylings of female folk singers, Indigo Girls.

The EVERY WOMAN CAN movement was founded by Health Foundations’ owner and founder Amy Johnson-Grass and its mission is to empower and support women in making informed choices for childbirth and their bodies. EVERY WOMAN CAN is a community for every woman, throughout womanhood, pregnancy, childbirth, motherhood and beyond. No matter what choices you make for your body or childbirth, we strive to support one another in recognizing the incredible strength and potential we have as women.

To celebrate this powerful mission, Health Foundations welcomes Ricki Lake and Abby Epstein, creators of the raw and thought-provoking documentary, the Business of Being Born. Lake is a well-known advocate in the birthing community having served on the board of the nonprofit organization, Choices in Childbirth for many years. In their keynote address, these seasoned advocates of the birth community will address informed decision making and natural birth. Lake and Epstein’s work and life’s missions embody the spirit of the EVERY WOMAN CAN movement, seeking to empower women with knowledge and choices and to recognize the extraordinary potential of our bodies.

The grand finale of this special evening will be an exciting performance from none other than Grammy Award winning folk rock band, Indigo Girls. Amy Ray and Emily Saliers are not only known for their hit albums and timeless ballads, but their profound political and environmental activism and support for women issues. Ray and Saliers will close the evening with a performance following the key note speakers and a social hour to allow time to connect and celebrate.

Health Foundations is proud to partner with Free the Girls, Nurture Project International and Esther’s Home to bring you this incredible night to remember. A portion of the proceeds from the event will go towards supporting these organizations and their commendable causes. Here’s a little bit about the work of these partnering organizations:

Free the Girls provides a unique opportunity for victims of sex trafficking to rebuild their lives through operating their own business selling secondhand clothing while going to school, establishing a home and caring for their families. Joined together with fellow survivors, these brave women sell second-hand bras to other women in need around the world. Health Foundations is honored to be an official drop off site for bra donations that benefit the Free the Girls organization.

Nurture Project International is a US-based, nonprofit organization that provides resources for communities impacted by crisis and disaster. Through the organization and support of volunteers, Nurture Project seeks to provide tangible services to those people whose lives have been negatively impacted by crisis and who are suffering the most.

Esther’s Home is a support center for victims of domestic violence that provides shelter, programs, education and counseling to women and children as they rebuild their lives following abuse. Esther’s Home seeks to equip women with the tools and support necessary to reclaim their lives and wellbeing following the traumatic experience of domestic violence.


Together with Health Foundations, these organizations eagerly await the EVERY WOMAN CAN event at Aria on December 9th, 2016. Please join Health Foundations for this momentous, once in a lifetime opportunity to join hands with women from around the world to celebrate a woman’s right to choose. To purchase tickets to EVERY WOMAN CAN, please visit the website at or contact Health Foundations directly with questions. We look forward to celebrating with you!

Health Foundations Birth Center is a freestanding natural birth center that provides a safe and supportive environment for women throughout their pregnancy, birth and beyond. Embracing a women-centered approach, the midwives and staff at Health Foundations are there to empower you and your partner as you journey through this amazing life-giving experience. To learn more about women’s care at Health Foundations, visit our website or call us at (651) 895-2520 for a free consultation with a midwife and for a tour of our Birth Center.

What the Allina Nurse Strike Means for Birthing Families

Given the news that nurses at 5 Allina hospitals are set to strike starting Saturday Sunday, there are a few things to keep in mind if you’re due soon and are facing the chances of going in to give birth and were planning to have your baby at United, Abbott, or Mercy, there are some things you should be aware of.

The replacement nurses will be trained in Labor and Delivery. That’s the good news. The bad news is that they will bring in their own ideas, which will very likely be very different than the hospitals regular protocols and policies. We have far better outcomes in Minnesota than, say, the South. Many of these nurses will be coming from areas with very high c-section rates, where waterbirth is banned, where there are de facto VBAC bans, etc. Be aware that you may face huge opposition from your nurse if she’s not normally around these things that families in Minnesota have come to expect as the norm.

Also, when replacements are brought in to any strike situation and cross the picket line, patient safety becomes a concern. Nurses unfamiliar with even where various items are kept or who will be struggling with an unfamiliar Electronic Health Record system won’t be able to provide the same level of care that the staff nurses can provide. Also, if staffing agencies had a hard time recruiting enough L&D nurses, patient ratios may be even worse than normal– a long time sticking point between the nurses union and Allina.

So, what can you do if you’re facing an impending strike and you’re days away from birth?

If you have the option to give birth at a non-Allina hospital with your current maternity care practice, do so. If you don’t have a non-Allina option, speak with your doctor (and since Allina is the only hospital group without a midwife group, it’s probably just a doctor that you have) about how he or she is planning to help keep patients safe during the strike. Will they be spending more time in the hospital while patients are laboring?

And even at this late stage, consider hiring a doula. She can’t provide medical care, but she will be able to be another set of eyes and hands and can help protect your birth, even with replacement nurses. It may be possible to hire a private doula, but I can get families birth doulas my non-profit. Our fees are on a sliding scale, too. You can find more info here.

It was stressful for patients during the last widespread strike, even though that strike only lasted 24 hours. Hospital administrators will always spin things to try to reassure patients, but parents have a right to understand that things won’t be the same.

If you have any specific questions, post them in the comment section!


6 ways to feel more productive while nursing your baby


do while nursing

One of the hardest parts once you conquer breastfeeding is that sometimes it makes you feel like you should be doing something…more productive. I mean, come ON…you ARE making sure your baby is growing and thriving, but we live in a society that eats quickly, and unfortunately, babies still haven’t been forced to adopt out weird societal norm. Throw into the mix that babies nurse not just out of hunger, but out of thirst, too, and it can be darn frustrating to be sitting on that chair, nursing your baby…again. So, I came up with some truly helpful things that you could do while feeding your baby.

1) Clean up your phone contacts- If you’re like me, you phone is full of all sorts of clutter and old info and numbers for people you really never want to talk to again. Going through and deleting bad info seems like a huge chore, but is a perfect thing to do with one hand. Think of how amazing you’ll feel when it’s all clean and organized!!!!!

2) Order hard copy prints of pictures from your phone- If you’ve ever had a phone stolen with all of your pictures on it, you know how gut-wrenching it is to no longer be able to look at the pictures you’ve been taking of your sweet kids. And the reality is, those digital pictures can’t be handed down to future generations. While it may seem quaint, actual pictures in photo albums or boxes are the answer. There are apps that let you order prints from your phone, and they all have free print offers. Future you will thank now you, I promise.

3) Learn a new language- My husband is trying to learn German through podcasts. I’ve long been interested in trying Duolingo, a free app to learn languages. Finding the time can be tricky. But if you use feeding time for baby as learning time for you–you may actually make progress!

4) Get a lower cable/internet bill- Yes, this one actually requires making a potentially frustrating phone call, but if you call, tell them you’re thinking of switching to the competitor, see if you can score a lower rate. It may work, it may not. It never hurts to ask.

5) Check you credit score- This one will make you feel like you’re really doing a great job of adulting. And to make sure you don’t go the the wrong place, here are the instructions from the State of Minnesota.

6) See if there’s money out there for you, friends, or family- Yep, this is a real thing. I’ve found money for family members. I’ve never found anything for me, but maybe you’ll get lucky and locate money you didn’t know you had. Here’s Minnesota’s program. You may want to check all the states you’ve lived in or relatives have lived in. Just makes sure you ONLY look via official state government pages.

And if you’re local and you want to meet other moms and chat with a nurse, make sure you check out Mama Cafe. It’s a free group for breastfeeding mothers held every Thursday from 10am-11:30am, held here at BabyLove.

Any other clever things you do while breastfeeding? I’d love to hear about them in the comments!



Do we expect too much from dads at births?

dads birth doulas

This month is International Doula Month, and as such, I’ve been thinking about what I really wanted to say about doulas that I maybe haven’t said before. There have been a few interactions I’ve had lately that really got me thinking, although this is nothing I haven’t thought about before or even mentioned in classes.

We expect FAR too much from dads during birth.

So, here’s the deal:

Back in the day, like 130 years ago or more, when a woman went into labor, the local midwife would come into her home. The mom’s female friends and family would come to help– they would prepare her a birth space,  soothe her, help keep her fed, hydrated, and reassure her. Birth was a normal part of life, something that most woman would be familiar with long before it came time for them to give birth as well.

I’ll say this again: Birth was a normal part of life.

The role of a birth doula is to try to bring into the picture those women who were very experienced when it came to birth. Unless you’ve been around a couple of women as they give birth before, birth is a pretty weird process that no amount of videos can ever prepare you for. So while I’m not saying we should go back to the time when it was considered “improper” for men to witness births, I’m saying that the idea of a partner having to bear the responsibility of caring for emotionally and physically supporting a mom through birth is unfair to everyone– it’s unfair to the partner, it’s unfair to the mother, and it’s unfair to the baby.

We have mounting evidence of dads (there is no info out on same-sex partners) experiencing PTSD as a result of being at the birth of their babies. Even if there aren’t ANY complications, while we should try very hard to prepare partners to be active participants at birth, there’s nothing to really prepare anyone for the twists and turns of birth. Doulas can’t predict how a birth will go, but they are prepared to walk the journey with families, no matter what that ends up looking like. Doulas provide that reassurance to EVERYONE during the process, no matter what, helping reduce trauma.

Doulas aren’t emotionally attached, not do they have to bear the responsibility for the medical care being provided.

Hiring a doula isn’t a value judgment on the state of your relationship; in fact, having a doula can help provide the space and time for those critical moments during labor and birth that can bring couples closer together.

Hiring a doula will not take away from a partner’s role at birth; having a doula present will give him more confidence to be involved in a way that he’s comfortable with.

Hiring a doula means that the laboring mother will have what’s very biologically normal– the care and support of an experienced woman who will stay with her through the whole process.

Hiring a doula isn’t a luxury. Hiring a doula should not be a status symbol. Hiring a doula should not be political. Hiring a birth doula is a logical, critical, SMART choice that can help ensure that no matter what happens at a birth, everyone in the room was able to benefit from the professionalism and reassurance and care that a birth doula provides.

I believe in birth doula care SO MUCH that I have created a non-profit that, in addition to providing mental health services, provides doula care on a free and sliding-fee basis. Families who are interested in doula care through The BabyLove Alliance can come to our Information Nights. Upcoming dates are May 20th, June 24th, and July 29th at 7 PM at BabyLove. Find out more information about our unique program here.

Hire a doula. It’s important.

Medical Bill Basics: Explained

medical bill explained

Ever since put out a video on how hard it is to determine the cost of birth, I’ve found myself wanting to put my head on my desk numerous times per day. If you haven’t seen it yet, check it out:

Some people have pointed out that there are tools to help figure out how much a birth will cost, though it’s usually on a per state basis. Late last year, you may remember that I did a couple of extensive blog posts where I took a few hours to pull together the information for Twin Cities costs for births depending on the mode of delivery and the health of the baby.

The problem with that, though? It doesn’t even to start to take into account one tricky little layer: Each health insurer has different contractual allowances that ultimately determines how much you pay.

So, let me explain it this way:

  • Louise has a procedure done. The provider bills her insurance $175 for it.
  • Louise’s insurance has pre-set a rate of $90.47 for the maximum allowable fee arrangement for that specific procedure.

A few ways this could play out:

  1. Louise has yet to meet her deductible, so she has to pay $90.47 out of pocket to the provider for it.
  2. Louise HAS met her deductible, but she has to pay a co-pay amount. In this example, let’s say she has a $40 co-pay. She would pay the $40 to the provider, and the insurer would reimburse the provider $50.47.
  3. Louise’s insurance has a 30/70 split on all billed costs. Louise then pays $27.14 to the provider for the procedure, and the insurer would reimburse the provider for $63.33.

And this can go on and on and on in various permutations depending on all of the possible plan set ups. A different insurer could set that maximum allowable fee at a paltry $30.17. (Good for their shareholders, totally awful for the providers.) Can you see how it would start to be totally impossible to actually get an idea of what birth would cost?

Keep in mind, too, that everything done during birth can be turned into a billed procedure. There’s no way to anticipate what that might look like, because some hospitals will even bill you a couple buck PER TYLENOL.

This situation is  really, really, complex and has a lot of nuance I don’t think anyone has tried to explain too hard. I’ve even tried my best to explain what the process of “taking insurance” looks like from the provider side, and that doesn’t even begin to scratch the surface of how awful and infuriating it is.

All this is to say that, yes, it is really complex. I have my own opinions of how US Health Care could be made less expensive and safer, but I also know it’s not as easy to unravel as anyone who talks about it thinks it should be.


Have I missed anything? Are you a health care smarty with something to add?




#RealMomConfessions: Therapy Rocks

Real Mom Confessions

At a certain point, I think we all get sick and tired of “National X Day” and “International Y Month”, but this month is Mental Health Awareness Month and International Doula Month. Both are really important things in my world, but today, as a mom* of two, I want to talk about mental health. More specifically, I want to talk about therapy.

I’ve been seeing my therapist for 15 months. It took a long time for me to get brave enough to start seeing anyone. I think I may have mentioned here before, but I saw some really yucky professionals in college and right after. They were so callous and uncaring that I thought that therapy had to be them versus me.

I was wrong.

I found my current therapist after asking an acquaintance for a referral. He gave me two names. One couldn’t take my insurance (but now is a trusted mental health professional in the non-profit), and the other is now my therapist. Thankfully, I really hit it off with my therapist, even though there were major hurdles in the beginning to get me into the building for every session. And no, I don’t want to talk about that. It had nothing to do with her, but everything to do with the demons I was facing.

Therapy has given me a safe place to process things happening in my life, as well as process things that happened in the past. She gives me perspective. She gives me courage. It’s my safe space to discuss what’s going on and helps me work things out in a totally non-judgmental way. I like myself better than I ever have. I feel great about the relationships I have. I feel completely OK about the relationships I’ve said goodbye to. I’m learning to trust myself, and that’s something you can never put a price tag on.

The hardest part about therapy is finding someone you click with. If you don’t click with someone, it’s OK to keep looking. Some therapists will even let you do a free consult to see if you are a fit. I mean, I talk here all the time about working to find a good fit for maternity care, and the same is true for mental health. Also? The most prominent names in the field, with the fanciest clinics, are probably not a good fit for anyone.

However, all of this is worth it. Taking care of your mental health, even on the days when you really suck at keeping it together, is worth it. Therapy is worth it.

You are worth it.

*The really crappy thing about mental health is that, once you have it in your record that you have an issue, it can, in some cases, become a stigma. Sometimes, when I make the decision to talk about these things publicly, I worry that people will look at it as a way to discredit me, my abilities, and my self worth/ You know what? Forget them. I’m not alone in what I live with. I just may be braver than some.