Pregnancy as health care 101


    First entering the health care system can be a daunting experience. There’s the condition you’re coping with, plus managing doctor’s appointments, tests and treatment, learning insurance jargon, and of course paying for it all. For many women, pregnancy is the first time they step into this world.

    The Marketplace Money show is broadcasting from Philadelphia this week.  WHYY/Newsworks’ Health and Science team filed several special reports for the show.  This is from reporter Kerry Grens:

    First entering the health care system can be a daunting experience. There’s the condition you’re coping with, plus managing doctor’s appointments, tests and treatment, learning insurance jargon, and of course paying for it all. For many women, pregnancy is the first time they step into this world.

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    I have been a health reporter for six years. But I’ve never walked into a hospital without a microphone. And in fact, I’d never really been a patient until I started coming in with something doctors and insurance companies code as V22.0. Also known as pregnancy. Now, as I sit here out of breath from my peanut-size lungs and my watermelon-size belly, I’m a regular. Midwife: So where is this kid kicking you mostly? Kerry: I feel the hiccups low down, and then I feel the baby usually on this side more. I’ve had twelve check ups, had my blood drawn, made two trips to the hospital for screening tests, and I’ve peed in a cup … a lot. Although I’ve interviewed people about their struggles with co-pays and getting procedures denied, my insurance paid everything but 20 bucks. Field: From the insurance company’s perspective they want to encourage you to get the prenatal visits because the payoff to them is huge. The difference between having a healthy baby and an unhealthy baby. That’s Rob Field. He’s a health care regulation expert at Drexel Law School. Obviously, preventing problems is cheaper than treating them after the fact. But insurers have another financial incentive to treat me well. Field: Insurance companies love having healthy young women about to give birth. It’s their perfect demographic. They then get a healthy young family…who are likely to not run up the bill. But I do run up a bill, albeit minuscule compared to cancer or kidney failure. And I didn’t even go in for the genetic tests and frequent ultrasounds that many women demand. After all the stories I’ve written about the downsides of screening tests – the false alarms the unnecessary interventions – I didn’t even want one ultrasound. Even doctors admit patients are over-screened and worry needlessly about nothing.   Except when it IS something: Berghella: If you detect it early, for example a heart defect or other defects, it has been shown that the preparations you make before delivery are going to improve the outcome. Leave it to Vincenzo Berghella, the head of fetal and maternal medicine at Thomas Jefferson University to knock me back into ‘what if’ mode. Even though very few babies have a defect, could I live with myself if I chose to skip this scan just to avoid a false alarm? So I got it. And now, I have a framed picture of the results on my bedroom dresser. It’s hard to resist buying in to what has become a medicalized condition. And one where women are encouraged to be hyper-cautious.

    Bob: Cigarette smoking, probably not a good idea. Caffeine, sugar substitutes…sugar substitutes?

    My husband Bob and I have been reading through a stack of popular pregnancy books. Full of warnings.

    Bob: Sports, hot tubs, microwave exposure.

    The problem with these warnings is that they don’t put anything into context. How long do I have to stand in front of a microwave for it to hurt my baby?

    Bob: I think in the end you’ve just like – what we’ve done which is to use out common sense.

    And I don’t stress out about the chemicals under my sink and the ingredients in my yogurt because stress is something I know is bad for me.

    I’ve been operating under the assumption that pregnancy is a healthy condition. And so I decided from the beginning that I didn’t need to see a doctor.

    Black: Midwives, we’re trained in the normal natural process. Versus obstetricians are trained surgeons. Nicole Black is a certified nurse midwife at a birth center in Wilmington Delaware. Black: And so I think sometimes you rise to the level of what your training it. And so it’s like, ok, there’s something going on here, it might be easier to do a cesarean. Versus midwives, we don’t necessarily have those skills, that’s not something in our skill set so we don’t go to that right away. Black’s not my midwife, but she was my inspiration. I had interviewed her last year about out-of-hospital births, and liked the idea. Given what I’ve reported about drug-resistant bacteria and hospital errors I’m wary of hospitals. But it’s just like with the ultrasound: even though it’s highly unlikely that something would go wrong, I couldn’t let go of the security of an operating room and an intensive care unit down the hall. And so I found a compromise: the midwives I see deliver babies at a hospital.

    Going the natural route opens up a whole new world of quasi-medical options. Take placenta encapsulation — eating dehydrated placenta like vitamins. Amy Borelli is a mother of three and a birth coach, and she makes placenta pills.   Borelli: I think I’ve been averaging about three or four a month. Grens: That’s a lot more popular than I would have thought. Borelli: Yeah, right? It’s a lot more popular than I thought! The pills are supposed to help with postpartum depression. I’m not totally sold, but I may do a story on it after I return from maternity leave. For now, I can entertain myself by thinking about baby names and breastfeeding and not about being sick. And that’s what makes pregnancy different from everything we lump under health care and pay for with insurance — As Rob Field as Drexel points out, it’s not a disease. Field: I think pregnancy does stand out in that regard as being something very positive that you get someone else to pay for, how often does that happen in life? For this reporter, at least once.

    Hear this and the rest of Marketplace Money’s special Philadelphia episode at 3 p.m. Saturday on WHYY, 90.9 FM.

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