Goodbye, St. Joe’s Birth Unit

 

This baby wants you to read all of the blog post
This baby wants you to read all of the blog post

This week, I was stunned to learn via Twitter that St. Joe’s hospital is going to be closing it’s maternity ward in September. This space has long been a place where I’ve provided my views and commentary on maternity care developments in Minnesota, including costs, outcomes, strikes, options…..

Changes in my life have meant that I can’t and don’t focus on the maternity care system as much as I did a year ago. But this change (and others, including HCMC’s idiotic decision to cut childbirth education and doula care as a means to fund a big shiny building, literally tossing aside a vulnerable population to plump up their bottom line) feels both seismic and inevitable all at once.

First, a few words about St. Joeseph Hospital and a disclaimer: My son was born there 9 years ago. It wasn’t my first choice, but it’s was my best option given our health insurance at the time.  I had one crappy midwife and nurse, left, came back after my water broke, had a decent midwife and good nurse, but was only able to eat crappy hospital food postpartum thanks to the Republican National Convention and tightened security rules. As a doula, I’ve had a mixed set of experiences there, including the one and only time the charge nurse hauled me into a room to yell at me. It’s cool though– it was after her staff seriously screwed up and yelling at me made her feel better.

To place St. Joe’s into context: It’s long been lauded as the place with the lowest cesarean rate in the Twin Cities. This is true. But there are a lot of reasons why this is the case. First of all, it’s been the hospital used by the OB group in MN with the lowest primary cesarean rate.  Healtheast in of itself does not have OBs on staff, so cesarean rates at their hospitals is pretty much a factor of the independent OB groups and admitting privileges. It’s also long been the choice of homebirth midwives when they need to transfer patients from home to the hospital. Yes, the culture there is different. But it’s also a hospital that lacks a NICU of any kind (and really barely has the capacity for Special Care Newborns), doesn’t have much in the way to care for high-risk pregnant people, and has had a ban on VBACs for over a decade (though rumors swirled constantly that the ban was going to be lifted–I guess we can put THAT to rest).

I have had a lot of thoughts on possible motives for the closing that I’ve been asked to share, so here you go:

  1. St. Joe’s became the hospital in the 5 county metro area with the fewest births within the Fairview/Healtheast system. From an organizational standpoint, closing the smallest unit makes some sense in the larger scheme of things. St. Paul residents lose a hospital option for birth in DT St. Paul, but the U of M has a NICU, midwifery care, perinatologists, neonatologists…so that allows for there still to be care that’s not just in the suburbs. Adding that capacity to bring St. Joe’s into line was never going to happen, either to build the facilities or hire the staff.
  2. St. Joe’s has the only birth unit that has never undergone any improvements…for a very, very long time. It was kind of dated when my son was born there, and nothing there has really changed since then. Woodwinds birth unit has been expanded once (or twice?) since they opened, St. John’s had at least two rounds of remodeling in the last 10 years, Southdale just finished a gigantic remodel last year, probably their third I can remember, the U has undergone remodeling, and Ridges has had a few improvements made over the years. I’m guessing though, that the merged hospital system took a look at the portfolio of birth options and realized that if they were going to stay relevant in the arms race that is maternity care remodeling (I’m looking at you, Allina, for exacerbating it), they had to decide if it was worth the millions of dollars it was going to take to bring the birth rooms into the same specter of luxury Twin Cities families have come to expect.
  3. I really do believe the hospital spokeswoman when she said it wasn’t going to be a job-loss situation. The addition of Midwives at Ridges and Southdale and the cultural shift that brings very likely could mean that some Labor and Delivery nurses will decide that the shift to offering midwifery care and waterbirths and nitrous oxide is more than they want to put up with and (hopefully) decide that they are no longer best suited to work within that climate of more patient-centered care.  The Fariview/Healtheast merger was probably the impetus for the addition of midwives at FV Southdale and FV Ridges. Healtheast has Nurse Midwifery care at all 3 of their hospitals, and Fairview has always had CNMs at the U of M hospital. Even though Park Nicollet/Healthpartners and North Memorial scaled back midwifery care, between the half a dozen or so freestanding birth centers that have opened and the creation of at least two new Fairview Midwifery clinics, there easily could be a very welcome, but very real, shortage of CNMs if there isn’t one already. The closure of the St. Joe’s birth unit is a way to more wisely reallocate resources. I have no doubt that the good care providers from St. Joe’s will continue to be good providers no matter how they are reassigned.

I’m sure, then, that you may be curious to hear my opinion on what other options people should consider.

For pregnant people who are drawn to giving birth in a place with as few unnecessary interventions as possible, any one of the freestanding birth centers is the most logical pick. In fact, some of the operational quirks of St. Joe’s meant that, in some medical emergencies, staff has to be called in–they aren’t always in-house. The freestanding birth centers do transfer to hospitals with that kind of staff in house 24/7. The difference is safety of care is pretty much non-existent in my opinion.

For families looking for more personalized care, I strongly encourage them to look at Family Med doctors as a viable option, especially those at Entira, in private practice, those who practice at North Memorial.

If you have to work with an OB, please check out the most recent annual report from MN Community Measurement. Go to page 135 in the report and look at the data there as a starting point to evaluate your options. But really, because so few OB births happened at St. Joe’s, this patient segment shouldn’t be affected too much.

Really, at the end of the day, I’ll give you the same advice I always have: Tour a couple of places. Ask questions. Don’t opt into care just because it’s the provider you’ve always seen. You are responsible for seeking out care that fits your needs. And if you find yourself hating a place or provider, there are ALWAYS other options. Oh, and hire a doula.

Warmly,

Veronica

I want to thank BringMN for linking to my Guide for Birth options this week, though I had a moment of panic because it’s woefully out of date. One other thing: The BabyLove Alliance, a 501c3 that I co-founded, is looking for help raising money to get us through the next step in offering affordable doula and mental health care to families. We are officially recognized as an Essential Community Provider by the MN Department of Health, but contracting with all of health insurers will take some $$. Please consider helping support that work with a tax-deductible donation

Thanks.

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Taking the “Baby” out of MotherBaby

Biased

Another letter arrived last week from Children’s Hospital reminding me that they were in the middle of major negotiations with Blue Cross Blue Shield of Minnesota. Reimbursement rates are the contentious issue, with one side that they need to pay less and they other saying they can’t afford to. As they got closer to a July deadline, I think it’s time for some straight talk about what this may mean. Not just to parents WITH kids earthside, but those parents planning to give birth at one of Allina’s cutely named “MotherBaby Centers”.

OK, I’m no fan of Allina, something I made abundantly clear during both strikes, as well as pointing out that they have engaged in the exact same kind of bait and switch that got a mom a massing legal settlement last year. Should Children’s lose their BCBS contract, families who are planning to give birth at Abbott, United, or Mercy will be facing the possibility of facing financial ruin.

Crazy, right? But here’s the reality:

The “baby” part of the MotherBaby Center is handled by Children’s. If your little one ends up in Special Care or the NICU, all care is then given by Children’s. Now, in the past, this arrangement has already hurt families–Allina’s Lactation and Children’s Lactation Services are by no means equal. Lost in the shuffle, parents don’t get a very important nurse visit after they go home. Communication between two entities can be pretty awful.

But if you have BCBS insurance and are planning on giving birth at any Allina facility– or even a system that defaults all very serious NICU cases to Abbott (Unity’s NICU isn’t quite as robust)–here’s what a lack of contract deal would mean:

You give birth. In the chance that your baby needs extra care, your baby goes to a higher-level care facility. You may gave your birth paid for, but the baby’s care won’t be in network.

Let’s say a mom is on BluePlus– a Medical Assistance plan administered through an outside company. If that baby goes to the Special Care Nursery or the NICU—will the baby get turned away? Will the parents be separated from their kids?

Or let’s say the midwives at one of the Minnesota Birth Centers or Health Foundations decide a baby needs extra help. All of a sudden a family is facing huge costs from being forced to get care out of network.

Or, as I have learned, a mom with prenatal care at another hospital system shows up at Abbott or United because the marketing makes it seem like a better choice, will they end up going through hell if they don’t end up with a healthy baby?

Do you see how this works?

Look, I’m not a huge fan of BCBS. They are doing some pretty wackadoo things to providers. They haven’t always been my favorite as a patient. But Children’s? With your stupid galas and fundraising? Have you thought this through?

Probably not. As is usually the case, the powers that be at the top think of the birthing patients and their babies last. I mean, after all–what’s screwing over a bunch of families if it means they have more money? It’s better to hurt the smallest patients than have a smaller bottom line, right?

Wrong.

-Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

My kids were born with obstructive sleep apnea

2005_1206009

Before I was a childbirth educator, I was a mom of a little girl. I’ve written about her birth before; I haven’t really ever thought to talk about how both of my kids were born with sleep apnea, and how it took forever to find a pediatrician who would actually believe me.

When I first brought her home from the hospital, I noticed almost immediately that my baby girl would regularly stop breathing for a couple of seconds, only to gasp for air. Initially, my new mama instinct wasn’t sure if I was just being overly paranoid, or if she really did stop breathing for a couple of seconds before the big gasps I didn’t think were normal. Her Mayo Clinic doctor (who was a total and complete ass, BTW), ignored my concerns– he told me she was just congested, and moved on to something else.

(As an aside, I should tell you some day about the nonsense “parenting education” material they would give me every visit. Knowing what I know now, there was very little actual evidence behind it. All it did was foster doubt an insecurity by creating parenting expectations that would never be biologically normal. Even better, if I could find the sheets, it’d be a total hoot to go through it with a big red marker!)

When my daughter was about 4 weeks old, after sleepless nights and too many days nodding off during the day while I fed her on the couch, a friend encouraged me to look into safe bedsharing. I found the safety guidelines online, and during one nap time, I latched her on while in the side-lying position in my bed, and we both fell asleep for a life-changing 2 hours. I was a convert from then on out. It wasn’t until much later that I realized that since she and I started sharing a safe sleep surface, I no longer noticed that she would stop breathing. Instead of sleeping next to me in her bassinet on her back (which, until very recently, was the only AAP-sanctioned sleep scenario), she spent her nights cuddled up next to me, on her side. Sometimes I’d wake up and find out that I’d been feeding her without remembering when or how the feeding started. And then, when she was 9 months old or so, she started to turn sideways in the middle of the night and stretch out as much as she possibly could. That’s when we transitioned her to a crib in her own room. And at 9 months, she would sleep in whatever position she felt like sleeping in that night. By that point, she was not only rolling and crawling, but walking on her own, too. SIDS and back-to-sleep stuff was no longer technically an issue for her.

However– she was back having very, very audible sleep apnea. We’d listen to what I now understand was the sound made when her tongue would fall into the back of her mouth, then the little “kuh” sound she’d make right before the gasp as she started breathing again. We’d joke in a moribund manner that the gasp at least told us she was breathing…eventually. Moreover, we’d started to notice that when she slept, she always slept on her stomach or he side with her head tilted back to straighten and open her airway.

When she was 2 years old–maybe?– we brought it up again with her doctor. Keep in mind, smart phones weren’t a thing yet. iPods were big and bulky and only had hard drives and were only for music. We could really only convey what we were noticing by trying to recreate it ourselves. Her family med doc was again dismissive, though he did say he could refer us for a pediatric sleep study, but that it would take 6 months before we’d be able to get in. Shortly after that, our basement flooded, my husband got a new job that required him to commute 90 minutes each way, and then I got pregnant with her little brother… and life got super chaotic.

Once my son was born, bedsharing was started from day 1. However, he didn’t really nap on his own until he was about 8 months old, and when he did, he’d do what his sister did– he’d stop breathing. As he neared the 9 month mark, when I would put them both down for a nap in the same room, I’d listen to the baby monitor as they took turns having apnea episodes (which I’m sure did NOT help my anxiety). I can’t remember if it was at a well baby visit for him or a well child visit for her, but I mentioned the apnea episodes their pediatrician, who referred us to a pediatric ENT. She got her tonsils out shortly after her 4th birthday. At that point, they had grown so large that she barely had any room to breathe while she slept. A few days after the tonsillectomy, we noticed that when she slept–there was silence.

My son had his tonsils and adenoid out when he was 3 years old. He was also able to breathe perfectly while sleeping a couple days after surgery.

So there you go. My kids had obstructive sleep apnea, and now they don’t. I do think that both of them had and have tongue ties for a BUNCH of reasons. I had recurrent mastitis, nursing was super painful at first with my daughter, she didn’t gain weight all that fast, both kids had EPIC spit-ups. One child had speech issues that have been resolved. The other one tongue-thrusts to swallow and is very sensitive to food texture.I often wonder if I had had them sleeping on their own in a room from day 1, on their backs and not near me–would we have had a different outcome? We know (and the AAP recognizes this) that babies NEED to sleep in close range to their parents for at least the first 9 months, in part to help them regulate their breathing. When humans sleep on their backs, the tongue can fall to the back of the mouth, causing snoring and apnea.

Finally, I do want parents to know that if your little one stops breathing and then gasps for air, that is NOT NORMAL. If they sleep with their head always tilted back—again, not normal. Listen to your gut, and if your child’s care provider dismisses you–get a second opinion. Or a third. I know that there’s so much more to learn about this, SIDS, and other sleep issues, but I do think that parents can go a long way if we share our stories and compare notes.

On that note, Happy New Year!

Warmly,

Veronica

 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Announcing Twin Cities Hospital Birth Costs at a Glance!

After last year’s epic process of compiling costs for births and newborn care, I was trying to figure out a more accessible way for parents to get the 2015 data. So, I created a more streamlined guide-at-a-glance.

This guide has a few features: health system affiliation is listed, allowing you to see how they differ in cost from company to company. It’s just two pages, making it easy to flip back and forth. I had fun compiling the information, and I hope you find it useful!

Warmly,

Veronica

Get your copy of Twin Cities Hospital Birth Costs at a Glance

* indicates required

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

What confident births look like

The weekend, during the Ready for Birth: Express class, I took a couple of minutes to show a birth video that I don’t always show; it was a larger class, and it was wonderful to have so many different families. Some were giving birth in birth centers, others in hospitals, some with OBs, others with midwives. There are a billion birth videos out there, but I love this first one because it’s a wonderfully accurate depiction of birth: the mom has intense contraction waves, but is able to still laugh a little during the breaks in between. It shows her moving around and changing positions. And more importantly, it shows how gorgeous birth can be when the person giving birth is surrounded by caring providers in a calm, patient environment. On Saturday, after this video, there weren’t many dry eyes.

The birth of Cody Taylor | Waterbirth at Mountain Midwifery Birth Center in Denver, CO from crownedbirthphotography on Vimeo.

Why do I want to show you these? Because birth is usually talked about in a way that’s scary. Because birth isn’t shown realistically on TV or in the movies. Because most people never hear about the amazing empowering, positive births– only the traumatic ones.

Here’s a birth in a hospital. It is another water birth, and I’m not terribly thrilled with how long it took to get baby to the surface, but it’s cool.

Milo’s Water Birth from David Mullis on Vimeo.

Here’s a hospital breech birth–keep in mind, these care providers are taught how to deliver vaginal breech births. It is something that is possible, but ONLY when the care providers know how to handle it. There are still quite a few places where vaginal breech birth is a skill still emphasized during education and training. Unfortunately, it’s not taught in the US on anything approaching a regular basis.

Nascimento Mariana, parto natural hospitalar pélvico – 04/jul/2013 – Natural breech hospital birth from Além D’Olhar fotografia on Vimeo.

A preterm birth of a wee double rainbow baby; again, the care provider is calm, patient, and caring. Births of rainbow babies are emotionally challenging. When a family gets pregnant after a previous stillbirth or miscarriage, there’s the very reasonable fear that another loss can happen. BUT, and this is important– in these cases, it’s even more critical to have a calm, caring, supportive birth environment rather than a fearful, negative birth environment.

Double Rainbow Baby, the Birth Story of Emilia from Jennifer Mason on Vimeo.

A hospital birth in—well, not the US. I love everything about this video. Again– you see calm, patience, and encouragement.

Thomas | Parto natural hospitalar from Ana Kacurin on Vimeo.

So here’s the deal: Everyone deserves this kind of environment during birth. Full stop. It’s not about medicated, unmedicated, natural, vaginal–it’s about understanding that birth is a normal biological process. It’s about a mother who is confident in her body’s abilities. It’s about having care providers and support people present who hold the space. Birth can be positive. It’s a lot of work, it’s never easy, but it doesn’t have to suck. A triumphant experience is possible.

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Fact vs Fiction in Modern Birth: An Intro

fact-vs-fiction-intro

Childbirth is distinctly different than any other discipline of modern medicine: Unlike every other medical specialty, humans have been giving birth for as long as– well, for all of human existence. As modern medicine started to really develop at the turn of the 20th century, childbirth– once looked at a normal life process– was taken over by doctors who at first really didn’t know at all what they were doing and had very little actual understanding of the female body or birth. That either the mom or baby made it through the process of birth in early hospitals was often a matter of luck.

I joke sometimes in class that so much of what’s wrong with birth in the US, with our rising maternal morality rates, is thanks to the arrogant, misogynistic, vain, and ignorant decisions made by men of the medical establishment since at least the 1850s. Who came up with the idea that episiotomies should be routinely done without evidence to prove their claims? Men. Who decided, without any evidence otherwise that once a mom had a cesarean, all births should be cesareans after that? A man–in 1912. And I’m not saying this to make a generalization that men are terrible, but to point out so many aspects of modern birth came from those without any real knowledge of the process. Once medical research really kicked in in full force in the 1950s, we saw some outcomes in maternity care improve, but not always.  Here’s where I strongly suggest that you read Tina Cassidy’s fantastic book Birth: The Surprising History of How We Are Born. If you want to know the full play by play of modern maternity care–this is the book you need to read.

The reality is, while there are a few things that can be measured and quantified about pregnancy and birth (hypertension really being one of the most obvious situations, followed maybe by cholestasis of pregnancy), many doctors who provide maternity care struggle to fully grasp that birth can be really hard to study. However, just because some aspects about birth can be difficult to study or quantify, that doesn’t mean that evidence-based maternity care doesn’t exist–because it does. In addition to the 6 Healthy Birth Practices as laid out by Lamaze International, other strong resources and proponents of evidence-based care can be seen in the Report from 2008 called Evidence-Based Maternity Care: What It Is and What It Can Achieve and in the joint consensus statement  Safe Prevention of the Primary Cesarean Delivery from ACOG and SMFM, originally published in 2014 and reaffirmed this year.

I am a strong proponent of intellectualism. Our shift to anti-intellectualism in all facets of life is more than a little disturbing. And while I can’t address everything in the world, I can go through some of the aspects of maternity care in the US and abroad, explain where they originated, what the original motivations were, and place those beliefs in the continuum between fact and fantasy. This post is an introduction to what I hope will be a interesting project. The next couple of posts will cover the rise of early birth “methods”…and then see where that takes us.

Are you ready? Let’s do this.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

More birth options at Fairview!

This month marks a decade since I attended my doula training at a hotel in Bloomington. I’ve been a huge birth nerd for a decade. Regular readers know I’m a birth nerd. Anyway….

I’d written in the past when hospitals have significant policy changes. I think the last time I wrote about it was when Allina instituted a waterbirth ban and Hudson Hospital banned VBACs. Or maybe it was as nitrous became an option at pretty much every hospital and birth center in the area.

A couple of weeks ago, I was SHOCKED (in a good way) to learn that Fairview had bought the Paul Larson Clinic practice. Evidently I was living under a rock, because that happened in the 3rd quarter of 2015. BUT…now they have a midwife group at the clinic. The midwives attend births at Southdale. If this doesn’t seem like much, consider the fact that Fairview, if you took the U of M hospital out of the equation, was one of only 2 systems that didn’t have a midwife group. Allina doesn’t have a midwife group that’s on staff (and they even went so far as to restrict access for HealthPartners midwives at Abbott). I was also told that they are working on hiring midwives for South of the River.

So here’s the thing: In the 2012 report, the Paul Larson clinic was the 2nd to worst in the Twin Cities for primary cesarean rate– way above the median rate in the state. The new midwives at the clinic under Fairview’s ownership have a cesarean rate of 5% so far. That is a REALLY big deal. Some people have complained that it’s not enough, but change happens slowly at first, and then there’s an avalanche of progress.

Also, Fairview Southdale began offering waterbirths as an option as of November 7th. Fairview was pretty much the last holdout (except for that time when Allina didn’t have them, but was still advertising that they did) on offering waterbirths.

Full disclosure: I haven’t attended a birth at a Fairview hospital in years. However, I have been impressed by the speed they have been adopting certain things: Fairview’s hospitals adopted nitrous oxide before St. John’s and Woodwinds. Having one, much less two, midwife groups on staff is….well, I still can’t wrap my head around it. It’s a huge as heck step.

Now, let’s celebrate the increase in options!

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Twin Cities Cesarean Rate Trends, 2005-2015

OK, so I’ve been collecting historical data on Cesarean rates in the Twin Cities metro hospitals from as far as I could go back, which was 2005. I’ve finally had enough time to pull it all together. There are some pieces of info missing, but here’s a decade’s worth of Cesarean rates:

twin-cities-cesarean-rate-trends

Back in March, I made some predictions for 2015 overall Cesarean rates. I had written:

Speaking of 2015 Cesarean rates, that info isn’t available, but I’m going to throw caution to the wind and make a few guesses. I think we’ll see an increase in rates at Woodwinds, a slight increase at Methodist and a larger increase at Maple Grove (largely as a result of the high primary rates from OBGYN West and Western OBGYN), increases at Ridges, Southdale, and Regions. I’m going to predict a drop in the overall censarean [sic] rate at Abbott Northwestern, St. Joe’s, and North Memorial. I don’t think there will be many changes at St. Francis, St. John’s, or United. As far as the Unity and Mercy…who knows. Now, we’ll have to see if I’m right.

 

So, how did I do?

I was right about Woodwinds, Methodist, Maple Grove, Regions, Abbott, and North Memorial. St. Francis saw a significant increase. St. John’s held pretty steady, and United had a teeny drop, but still a decrease in their Cesarean Rate. St. Joe’s saw the trend continue, with an increase in their rates that began in earnest in 2010. Woodwinds trended higher again in 2015 after a decrease from 2012 to 2014. Regions, Waconia, and St. Francis had the most significant increases, While Stillwater and Mercy had the largest decreases. And THANK HEAVENS that Abbott has made significant strides in reducing their overall cesarean rate after 2010.

See my previous post if you have questions about why this stuff matters. Otherwise, these trends are very interesting to look at! Now to wait again until data comes out in March again….if it comes out. If you’re looking at this data and mad that more isn’t out there, well, start pulling together the resources to get laws like the ones in New York passed. Without a state grassroots effort, we get what we get and we don’t throw a fit, unfortunately.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

2015 Minnesota Cesarean Rates

Update 10/12/16: Corrected tables have been posted below and the old numbers have been removed.

I have had a very, very long day. Very long. A long week, actually.

But enough about me. It’s my favorite thing ever! Time to figure out 2015 Cesarean rates!!!!!!!

I can’t even tell you how excited I was when the raw data from the Minnesota Hospital Association was available. I’m SO excited that I’m going to post all of the rates for hospitals with more than 100 births. There are some limits to the info that’s released publicly, but this is true for any health information that’s made public: numbers that were small than 5 were not reported. There is a whole category that only 5 hospitals in the entire state had numbers high enough to count. This info is the best I can do right now with what info there is. It may change after a good night’s sleep and my eyes are no longer crossed.

More posts will come in the next few days, including some handy-dandy printables you can use because, while I’m thankful for the Pawlenty Administration for mandating this info get released, ease of use was not a priority.

Enjoy, and be peaceful to one another.

updated-2015-mn-cesareans

page-2-cesarean-rates

 

 

 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Insurance reimbursement for childbirth education

With third-party reimbursement for childbirth education, one of the biggest barriers that exists in policy discussions is that not all stakeholders, including the educators themselves, understand what the current system is. The system is intricate and always changing, but on the surface, it boils down to three things: What is covered, who can render services, and how much are they paid.

Part of our existing insurance system is controlled by the federal government. A good example of this would be how the Affordable Care Act mandated that breast pumps and breast-feeding support was a covered benefit. Otherwise, most healthcare regulation decisions are made on the state level. This is where childbirth education falls right now: the coverage varies from state to state, and can change as new statutes are passed.

In Minnesota, childbirth education is considered a mandatory covered service by the Department of Human Services for residents who have coverage through Medical Assistance programs. Strangely, newborn care education is not considered essential, so as a standalone class it is not a covered service, but birth classes that include this information can be billed to insurance. Residents who are on Medical Assistance are either enrolled directly through the state’s Medical Assistance or MinnesotaCare coverage. Some of the plans are managed though the state itself, but most are have PMAPs (Minnesota Prepaid Medical Assistance Project plans) that are administered through Managed Care Organizations.

So then, in Minnesota, not all employer-based insurance plans or plans purchased by individuals have the same coverage parameters. So while some do reimburse providers for in-person group classes, other health plans consider access to online information or sending pregnant patients a book as an acceptable way to deliver childbirth “education”.

Most state’s health departments then decide who can provide services– what kind of credentials they need to have and if they have to bill under a supervising provider. Again, in Minnesota, I have to operate under a “supervising provider” as an LCCE. It usually doesn’t take much digging, but each state is different, so what applies here may be different, but states are currently in charge of the “Who.”

As for the how much…that gets really complicated. Reimbursement rates for Medical Assistance services are set at the state level, and many of the rates haven’t been adjusted for inflation in 10-20 years. Employer-based plans set their own reimbursement rates, and those rates can vary even within the same insurer as determined by what the employer has negotiated. For example, you could have Blue Cross Blue Shield insurance and the contracts would say that if the provider bills the insurer for a procedure at $150 and the contractual obligation would be to only reimburse $110 of that money; Somebody else with a Blue Cross Blue Shield insurance plan with a different employer might have that same service reimbursed at $97 when it was billed for $150. And then you have some other insurers who would take that $150 that was billed and only reimburse $35.

Not just anybody can bill insurance though, even if you are providing care within the state’s parameters. If you are not contracted with an organization as a provider, then anything billed would be out of network and would be subject to reimbursement rates set by the plan for out of network reimbursement. This really only applies to employer-based or individual plans; I’ve yet to find a state that allows billing reimbursement for out of network providers.

Hopefully this brief explanation helps you understand the very basics of third-party reimbursement for childbirth education as it exists today. If childbirth education is covered depends on which state you are in. Who can provide that childbirth education in a way that’s billable is also up to each state. The how much is something spelled out by each plan coverage. It’s not an ideal situation in the slightest; however, anyone who  wants to fix something first needs to understand how it works, otherwise it’s very likely any attempts to fix it will break it.

I am hosting a series of workshops, first for doulas locally, later for birth professionals via webinar. If you’d like to notified of upcoming dates, sign up for the professional development newsletter below.

Subscribe to our mailing list

* indicates required




Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.