More Allina Strike Concerns

Monday’s post on the Allina strike has hit 4,000 views—in 48 hours. People are reading it, people are sharing it, which is great, but you guys? I’m not being hyperbolic when I say this– it’s going to be worse than I thought. I met Lisa in person, who was super brave to share her story, today. She’s been amazed at the response, that anyone cares what her experience was. And yes, she gave me permission to share all of this. But the more I learned as we spoke, the more disgusted I am with Allina’s CEO and administration to allow another strike to go on.

Once the strike started and after her Cesarean, not only was Lisa (and at least one other mom) left in recovery for HOURS– at least 2, maybe 3—without a single staff person checking in (AFTER SURGERY), once Lisa and her baby were finally taken to the postpartum wing, the room she was in didn’t have any diapers, and all attempts that Lisa and her husband made to get a nurse to help with anything were refused. They would not bring medication. They never asked what she was doing to feed her baby.  She was at least experienced enough with breastfeeding that she knew what she was doing, but if she needed formula, I don’t know if anyone would have been there to bring her any. The replacement overnight nurses did not check to see if her son was being fed. LISA WAS NEVER FED, save for some crackers her husband managed to find, until she reached out the next morning and after her midwife raised hell to get Lisa any care in any way, shape, or form.

So, let’s get this straight: I have seen union propaganda. I have been very diligent in getting as much detail as I can on all sides of this issue. I am not sharing this as union propaganda. I am sharing this because I am TERRIFIED to learn what hundreds of other moms and babies were subjected to during the strike. I’m sure Lisa’s experience was what everyone else had to go through. In 4,000 page views, nobody has told me anything was inaccurate. I’ve had people reach out and confirm that Lisa’s experience was a fair representation of what it was like and will be like during another nurse strike.

Someone needs to tell me why this is ok: A mom who gave birth at Abbot Northwestern during the June strike gave birth via major abdominal surgery, was left for hours immediately following with no care, was brought into an actual room with no diapers, nobody checked her vitals or her son’s vitals after major surgery. Allina’s replacement nurses did not care if she was fed. They did not care if the baby was fed. It wasn’t until an outside party stepped in that Lisa and her son had any care whatsoever. Most people who give birth at Allina don’t have the access to their OBs that would have allowed them to have an advocate that would have raised hell and gotten them care.

I’m sharing this because somehow, someone needs to speak up. This isn’t about not having a birth go a specific way. This is about a hospital system refusing to make sure that their patients are cared for in the slightest. Allina’s powers that be need to tell me why they are OK with letting their patients get not just sub-standard care, but likely absolutely no care, no food, and without their basic medical needs met. Allina’s CEO kept saying the staffing levels were adequate. She was either misinformed or outright lying.

As women, we are often told that as long as are babies are here and alive, we should shut up and be thankful. I’m here and I’m going to rock the boat for Lisa and for that other mom in the recovery room with her and for the hundreds of moms and babies that I have no doubt weren’t provided basic care. I have a blog. I have this platform. I can share Lisa’s story and hope it gives others the courage to speak up. Otherwise, I’m mad, I’m sad, and I’m scared.

If you need or want to reach me, the office phone is 651-200-3343 and I can be contacted by email at veronica@babylovemn.com

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.

The Allina strike will put birthing families in grave danger

I have been blogging for almost exactly 5 years in this space, and maternity care outcomes and transparency hold a special place in my heart. I don’t know if anyone gets as excited as I do when new info comes out. After a lot of thought over the weekend, I am posting this. Buckle in.

The Allina nurse strike saga continues. In June, the nurses went on a 7 day strike. Back then, I had concerns about the safety of giving birth with replacement nurses. Now that a strike date of September 5th at 7am has been set, and after careful consideration, I can’t say this without enough emphasis: DO NOT HAVE YOUR BABY AT AN ALLINA HOSPITAL DURING THE STRIKE. CHANGE PROVIDERS AND/OR PLACE OF BIRTH NOW!!!!!

I may not make any friends with the system’s physicians or administration, but the evidence is more than circumstantial to back up my warnings. While I understand the political forces at stake with public opinion of unions in general, staffing ratios and staff safety are always issues at Allina. And in fact, the National Labor Relations Board ruled that the Minnesota Nurses Association’s complaints about unfair labor practices were with merit.

Historically, Allina’s hospitals have had some of the highest cesarean rates in the Twin Cities Metro Area. Recently, a change was made and births are no longer done at Unity Hospital, but in 2014, the c-section rate for Abbott Northwestern was 30.2%, it was 28.3% at Mercy Hospital, and 30.4% at United Hospital; all of these are above the state average of 26.9%. In 2014, 11,207 births occurred at Abbott, United, Mercy, and Unity–an average of 217 per week. With such high volume, Staffing problems will hit maternity services hard. Lactation services are sure to be hit hard as well, as union IBCLC RNs will also be on strike, so moms will have a very hard time getting appropriate breastfeeding help.

The last strike, which was limited to 7 days, cost Allina $20 million. On social media pages, nurses from other parts of the country are posting information they’ve received from staffing agencies recruiting workers to fill in for the striking nurses. Replacement nurses are being offered $6,900 per week and are not required to be licensed to practice in Minnesota. Additionally, because of such a high cost to replace nurses and because of the very large number of striking nurses (4,800), there is absolutely no way that Allina’s hospitals will have adequate staffing– in fact, only 1,400 nurses were brought in during the strike in June. A hospital system with a whopping 71% reduction in nursing staff is without a doubt incapable of providing safe care. While this creates a dangerous situation for all of the hospital units, because safe staffing ratios are so high– 1:1 nurse to patient ratios during labor and birth, and 1:3 nurse to patient ratios postpartum, there’s no doubt that having less than 1/3 the normal number of nurses will put mothers and babies in grave danger.

Very specifically, replacement nurses can’t provide appropriate care in the “Mother Baby Centers” of Allina hospital because:

  • Nurses will be much slower at charting in a system that they aren’t familiar with. Even if the nurses are familiar with EPIC, the most common EHR in our area, each organization has their own unique configuration. In births, charting is extensive– many, many things need to be documented in real time, taking away the nurses’ ability to provide patient care.
  • Maternity Care practices in our area are very different from those in other parts of the country. We tend to have better outcomes than in other parts of the US–meaning the replacement nurses will probably be used to maternity care practices that are considered outdated or unsafe. So, for instance, while Allina hospitals have Nitrous Oxide as an analgesic option for birth, it’s still rarely used outside of our metro area. Because the replacement nurses won’t have the training needed to provide Nitrous, parents will very likely find that options they expected to be available aren’t.
  • Patients with high-risk pregnancies are very likely to have replacement nurses that lack the higher training needed to keep medically fragile conditions under control.
  • Staff morale in hospitals during strikes always takes a major hit, distracting from the real need-providing patient care.
  • Even if the nurses were perfectly trained to work as Labor and delivery and postpartum nurses, even if they knew exactly how to use the Electronic Health Record System– In no way, shape, or form will there be nearly enough nurses to provide safe care.

When I previously wrote about my concerns, I wasn’t sure what birthing mothers would end up experiencing. However, last week, I made contact with one mother who gave me permission to share her story. Her name is Lisa, and her story follows:

I planned birth at Abbott due to VBAC.  I was aware of the strike and very concerned that I would go into labor during that time, but I was planning to birth with my midwife and with my doula and I was reassured that I have nothing to worry about. In fact I’m going to say what no one said to me when I was worried about the strike: RUN! I know everyone might not agree with that, but I speak from personal experience. I moved back from Alabama so that I could receive the care we’re accustomed to here in MN, and I still ended up with nurses from states where I would never give birth.  My due date was 6/19.  Same day as the strike. Water broke 6/16.  Labor never started so I went in 6/18 at 4am for Pitocin.

24 hours later [early in the morning of June 19th, the day of the strike], I’m laboring hard on Pitocin. I have a wonderful supportive Allina nurse. The best nurse I’ve ever had, but there’s a tension in the room so thick that you could cut it with a knife. We all know she has to go home at 7am, when her shift ends and the strike begins. In just 3 more hours. It was awkward. There was an elephant in the room. I considered asking her if she would stay with me but that seemed awkward and inappropriate.

So 7am came and she said “I’m sorry, I have to go now. ”

After that I had a stream of nurses. “I’m you nurse now. ..no I’m your nurse now. No I’m your nurse again.” I was in the shower and they kept interrupting me. I had a doula and a very supportive husband. I just wanted some privacy at this point, I wasn’t asking for extra support.

At another point I had nurses just standing around me with their arms crossed. Just watching me. Like they had never seen a woman labor before. Like I was a fucking zoo animal!!!!

At another point, one nurse was giving another nurse a tour of the room. “Here’s the warming station…” and then the two of them stand in front of the computer and discuss how the medical system works. I just hear whispering and taping on the keyboard. I’m butt ass naked, standing at the foot of my bed, huffing nitrous every 2 minutes for 90 seconds. I can barely speak. I’ve been at this for 30 hours. I wave my hand at them “They need to go. They’re distracting me.” I’m begging/irritated. My midwife then shooed them away.

This still pisses me off. I shouldn’t have to protect my own birth space like this. My midwife was there and my doula and my husband. But no one said anything. I had to ask them to leave.

It’s no surprise that soon after this I lost my ability to handle my Pitocin induced contractions. I asked for an epidural. Then my contractions went to 18 minutes apart and I ended up with a cesarean, again. Cesarean was 6/19 at 6pm.

They surgery itself had some parts that were less than what I would expect from Abbott and my post surgery care was grossly negligent.

I actually had to page my midwife on call during the overnight hours.  When the baby was born (unplanned cesarean ) we were told he could stay with us but would need to have his temp closely monitored due to prolonged rupture of membranes.  But they never checked his temperature the entire night.  Nor did they check my bleeding on the night shift.  It literally felt like everyone had left the hospital,  apocalypse. When she [the midwife] called me back I told her that I wanted to transfer with my baby to another hospital because no one was taking care of us. I paged her just after 7 am.  I knew I was supposed to have a new nurse and still no one had come to check on me or the baby.   I told her I was scared because we weren’t being monitored  and wanted us to be transferred to another hospital,  by ambulance if necessary.  She said “hold tight,  I’ll see what I can do and I’ll call you back.”

It’s my belief that when she hung up with me she called up there to the hospital and raised hell, because within a few minutes I has my day nurse and the charge nurse there.  They helped me clean up the blood that was dried from my waist down, changed my sheets and got me some food.  And filled out the white board.  There was definitely a turnaround of my care at that point.  My midwife called me back about 8am on June 20 and asked if I still wanted a transfer,  and  told me she could make it happen.  At that point I said we had a new nurse and I  felt safe again.  I told her we would stay.

Hiring a doula won’t be enough. Every single birthing family  with babies due in the next month needs to change plans on where to give birth, which likely will result in also changing providers, and they need to do it NOW. Changing is easy– I’ve outlined the process before. If you’re late in the game, you may need to change to a Family Med Provider who does OB care or an OB group. If you need help sorting your options, I’m happy to help. Call or email me– 651-200-3343 or veronica@babylovemn.com.

And Allina union nurses? I have your back. Allina’s C-suite? You are putting people at risk with your ongoing actions, and you need to be ashamed of yourselves.

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.

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.

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.

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.

Waterbirth

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.

Warmly,

Veroniva

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 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!

 

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.

Medical Bill Basics: Explained

medical bill explained

Ever since Vox.com 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?

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.

Primary Cesarean Rate By Group: Thoughts

I promised some thoughts on my blog post with the medical group rates last week. I was really interested in how many people actually clicked through to read the long as heck report! That’s awesome! But in some discussions online, a few things came up that need clarification.

First of all, this report is put out by Minnesota Community Measurement, an non-profit. I just find it and try to boil down the information in a way that’s more manageable. A lot of people were also wondering why some groups, namely midwife groups and family med groups, weren’t on the list. Here’s the exact methodology, as found on page 175:

This measure assesses the percentage of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section between July 1, 2014 and June 30, 2015 patients who had a C-section delivery. Any clinic that is part of a medical group in which the medical group has providers who perform cesarean deliveries were eligible to report data for this measure.

The statewide rate for Maternity Care: Primary C-Section Rate was 22 percent (a lower rate is better for this measure). Table 26 displays the details of this statewide rate. Figure 12 shows the average rate for this measure over time.

In maternity care, patients often seek care from multiple providers across locations within a medical group. Additionally, there are some providers who provide maternity care but may not perform c-sections, and patients who require a c-section are referred to a physician who does. Previous clinic level reporting of the maternity care measure did not include the deliveries performed by providers at a site without providers who performed c-sections, and as a result, rates for the state and at the medical group level had the potential to be artificially elevated. The maternity care measure is most appropriately calculated and reported at the medical group level in order to account for these considerations.

A few other people bemoaned the fact that we don’t have info on VBAC rates versus repeat cesareans. I agree. Given that, out of their whole existence, this is only the third report that MN Community Measurement has put out that has any Cesarean information, we’re really lucky to have the info we have. And really,  maternity care transparency is just a problem in Minnesota– we don’t really have any. We have a teeny bit, and I share as much as I can find.

OK, but my thoughts on the numbers:

For their volume, Park Nicollet had a really impressive primary rate of 20.1%, though it was up slightly from last year’s 19.2%. Since being bought by HealthPartners, which had a rate of 21.7% in this report, I do worry about the Park Nicollet number creeping up. Oh, and if you remember back to the post on costs of birth, there’s a major difference in price between Methodist and Regions.

In groups that had drops, I’m really impressed by John A Haugen Associates at 16.2% ( down from 21.2%), Multicare Associates at 19.3% (previously at 29.5%!), Adefris and Toppin Women’s Specialists down to 21.9% ( from 27%), and the biggest group on the list was Allina Health Clinics who was at 21.6%, down from last year’s 25.8%.

Hennepin County Medical Center, which had high marks in the 2012 report from MNCM, had an even worse showing than last year, going from 24.7% in the 2015 report after having a primary cesarean rate of 19.1% in 2014’s report. I’m curious to see how this will be reflected in the 2015 cesarean rates.

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 rate at Abbot 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.

What do you find interesting about all of this? I’d love to know your thoughts!

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 Twin Cities Medical Group Primary Cesarean Rates

I’m a big nerd when it comes to birth data. Maybe you’ve noticed. So when new information becomes available, it’s like Christmas to me. Yesterday, I figured out that MN Community Measurement had finally released their 2015 Health Care Quality Report. For the second year in a row, they reported Primary Cesarean rates by Medical Group.

So, some good news. The State’s rate of primary cesarean dropped from 22.2% to 21.9%. After a decade of rapid increases in cesarean rates, this is just another measure that shows we’re going in the right direction. Whee!

OK, time for the real stuff. From highest rates to lowest, here’s what the report has for Medical Groups. For comparison, I put the rate from 2014’s report in parentheses.

  1. Allina Health Specialties- 34.7% (27.9%)
  2. Comprehensive Healthcare for Women- 33.0% (30.5%)
  3. Western OBGYN- 29.2% (26.1%)
  4. OBGYN West-27.9% (24.1%)
  5. Women’s Health Consultants- 27.0% (24.9%)
  6. Metropolitan OBGYN- 26.0% (29.5%)
  7. Partners OBGYN- 25.2% (27%)
  8. Clinic Sofia- 25.1% (25.1%)
  9.  Obestetrics and Gynecology Associates- 24.8% (21.9%)
  10. Hennepin County Medical Center Clinics -24.7% (19.1%)
  11. Fairview Health Services- 23.5% (24.8%)
  12. Adefris and Toppin Women’s Specialists- 21.9% (27%)
  13. Healthpartners Clinics- 21.7% (n/a)
  14. Allina Health Clinics- 21.6% (25.8%)
  15. Southdale OBGyn Consultants- 21.5% (21.6%)
  16. Park Nicollet Health Services- 20.1% (19.2%)
  17. North Clinic- 19.6% (24.4%)
  18. Multicare Associates- 19.3% (29.5%)
  19. U of M Physicians-18.4% (17.3%)
  20. Oakdale OBGYN- 16.3% (18.7%)
  21. John A Haugen Associates- 16.2% (21.2%)
  22. Hudson Physicians- Minnesota Healthcare Network- 14.9% (11.8%)
  23. AALFA Family Clinic- 4.7% (13.0%)

You can read the full report for 2015 here.

Coming up in the next post, I’ll share my thoughts on some of these numbers. In the meantime, enjoy!

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.

Is there a problem with doula care?

Last week Choices in Childbirth released a report on doula care and insurance coverage. As someone who is deeply interested in the subject (and very opinionated on the specific barriers and possible solutions), I found it very interesting and even useful. Unsurprisingly, the report also became fodder for an anti-doula option piece. On Slate, Elissa Strauss wrote the very click-baity titled piece “More Doulas Can Lower the Cost of Childbirth. There’s Just One Problem.” My mom actually ended up sending my the link, asking me if I could believe what she wrote. I read it. I yawned a little. It was nothing I hadn’t heard before, but I think it’s still a good idea to address her article point by point.

Point #1:  Doulas aren’t regulated or licensed

Yep, this is totally true, and realistically, it is creating a major issue in many ways. In fact, Strauss writes,

Anyone can call themselves a doula without any training, certification, or practice. I could declare myself a doula right now. So could you.

Some doula trainers that I totally respect and admire have pointed out the number of certifying organizations has increased exponentially in the last couple of years. Every program is a little different, some requiring more documentation than others, some having in-person trainings while others are mostly done online. Not every organization promotes certification, either. Certification can protect families by knowing that, absent any other regulations, the doula can be sanctioned by her certifying organization. I am a birth doula who was trained to be a doula in November of 2006 and have been certified through DONA International since August 2007. Currently, no doula organization is accredited, either; however, Lamaze International IS an accredited childbirth education program.

I have more opinions about this specific subject than can fit in this post, but parents can still find doulas who are held responsible in some way, shape or form. Which brings me to her next point:

Point #2: Some doulas resent certain protocols

OK, so this is a really sweeping generalization, and I’m not sure if it makes for a good argument about why doulas are in of themselves bad. However, yes, my experience in the last 9 years is that there are doulas who can push the limits of what a non-licensed professional can and should do. However, in the absence of a standardized Scope of Practice (I follow the scope and standard of practice as set forth by each certifying organization depending on which hat I’m wearing), it’s up to the hiring party to figure out what that needs to look like.

Point #3: They are biased!

This is a tricky as heck little paragraph. Strauss states,

With standardization, women, as well as insurers, could feel confident that the doula they hired would be providing them with sound advice. This means providing information that is accurate as well as unbiased. Doulas currently have a reputation as being advocates for intervention-free childbirth; for many of them, having an epidural is a sign of personal weakness and/or capitulation to the medical industry and maybe just a big, fat failure. (Note how the report mentioned above doesn’t distinguish between C-sections and epidurals in terms of their potential value to mothers.) There are some good—if often overstated—reasons to avoid epidurals, but there are also manygoodreasons to get one. It would be unfair to women to populate our labor and delivery units with doulas who insist that childbirth will not hurt too much if the mother just remains calm and breathes.

First of all, as I’ve stated before here, too often the discussion of pros and cons is labeled as being biased. As far as I know, at no point was the CiC report meant to be a comprehensive report on the use or overuse of maternity care interventions. If Strauss needs to be enlightened on evidenced based maternity practice, I’d suggest she start by looking at the groundbreaking Obstetric Care Consensus “Safe Prevention of the Primary Cesarean Delivery” released by AGOC and SMFM. Maternity care in the US needs to be be improved in all metrics, including cost.

Second, all humans are biased. All professionals are biased. However, some are better at recognizing their biases and at removing those biases from their day to day professional interactions. As a doula, I would never, ever talk a mom out of an epidural. Now, that’s different than telling a mom who has a baby’s head halfway out that the epidural might take longer than the one push needed to finish giving birth. No care providers, be they doulas, nurses, midwives, or doctors, should ever, ever, EVER disrespect or manipulate patients. Period.

Point #4: I didn’t have one

Whenever I read or hear discussions about public health policy, it’s really silly to bring any one person’s experience into the larger discussion. Really, it’s not how anything scientific ever gets done. Since Strauss didn’t have one, it’s a great reason to ignore a really well-done report, I guess. Or it’s not. Let’s go with this being a bad reason to ignore the report, ok?

Overall, the piece points out nothing that those of us who are working on doula care access don’t already know, namely that we have a lot of work to do on standardization and definitions before we can even talk about reimbursement. And on it’s face value, it’s possible that Strauss could have written a more thoughtful piece on the other issues that exist in doula care being covered health services. Instead, it comes across as a piece to justify her own rejection of doula care under the guise of commenting on the Choices in Childbirth/ Childbirth Connection report.

Interestingly enough, the use of doulas to improve a medicalized life experience have popped up in conversation about health care on the other side of the life continuum: Death. PBS’s Next Avenue brought up the topic this week. My ideal solution to gain access to doula care as a covered service recognizes that there is a need for emotional and physical support for patients in many different health care scenarios. A proper doula serves as a conduit, a guide, a translator, and a constant companion who is wholly invested in the emotional support of the patient and his or her family. Doulas fill the gaps.

My post is by no means meant to be a comprehensive discussion on the state or future of doula care. I do have very practical, actionable ideas on insurance coverage of doula services that I’d be happy to talk about with people in person. But just because a writer on the XX Blog thinks doulas are terrible, it’s no reason you should too.

Speaking of doulas, the non-profit I run, The BabyLove Alliance, Ltd, offers doula services on a sliding scale. Our very first Doula Information night is coming up on January 29th at 7pm at BabyLove at 4590 Scott Trail, Suite 102, Eagan, MN. Come meet our doulas (who aren’t pushy, btw), find out what makes our doula services more complete than anywhere else, and ask any questions you have about having a doula at the birth of your baby. Email info@thebabylovealliance.org or call Veronica at 651-200-3343 for more information. Spread the word!

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 Hospital Baby Costs

Twin Cities Baby Costs

In case you missed it, last week I published a blog post that compiled the costs listed on the Minnesota Hospital Price Check website. Like I said then, there are some limitations on the information; those numbers don’t reflect variations in deductibles, co-pays, and co-insurance. Also, I used the “Average Cost”, which takes into account that various hospitals and various conditions have longer or shorter average lengths of stays. However, it’s a number that makes for some useful comparisons.

One thing I wanted to mention: If you’ve been following this blog over the last 4 years, you’ll know that I think this data is exceptionally important to help parents pull together the information that they need to make decisions about safe births. Giving birth is the one “medical” life event that usually allows people enough time to plan and ask questions in preparation for finding good care. Where you go and who your care provider is is THE biggest factor in determining outcome. Not mom’s health. Not baby’s health. And certainly, hospitals are businesses (although non-profits), so following the money is really important.

I love to have in-depth discussions about these things in my childbirth classes, and I love to help families who are unsure about their options or the choices they made ask the questions they need to ask to find the best care for their family. It’s a huge part of Lamaze education, and it’s something I think every parent can benefit from.

Back to today’s chart. Most births involve healthy newborns, but there are times when complications arise for baby. For this reason, I included 6 total diagnosis codes in the chart. Some hospitals, due to lack of appropriate facilities to care for sicker babies, won’t have data listed; they transfer those babies to hospitals with NICUs. Also, in the “Prematurity with Major Problems” and the “Extreme immaturity or respiratory distress syndrome, neonate” categories, you’ll notice some hospitals have very low costs listed compared to other hospitals. Those “cheaper” hospitals had very few babies in 2014 with those diagnosis codes, usually less than 10. Those are outliers that can mostly be ignored. And certainly, this doesn’t capture all the intricacies, so I urge anyone who really wants to know more to look at the data on his or her own, or leave comments below.

Baby Hospital Costs

If you think this is valuable, please check out everything I offer at BabyLove and come see me!

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.