Re: [ozmidwifery] axa

[Justine Caines]

Title: Re: [ozmidwifery] axa

Hey Jo and All

In all our lobbying at a state and federal level, we, (Barb Vernon and I) have come to the realisation that the dudes resp for insurance (state based insurance authorities) and the fed minster have not a clue on the “risk profile” of promoting specialist obstetric care as the norm.  To them birth that is not in specialist hands is “risky”, we use the GP/specialist analagy a lot.  Where else can a woman just decide to use specialist resources, with no medical indication?  Oh I have a sore chest, off to the Cardiologist!.  Midwives are the primary carer of pregnant women and it is them that should decide when on consultation is appropriate FOR ALL WOMEN.

What insurers need to understand (or be made to by us) is that utilising a practitioner that is an expert in the abnormal will skew the care in that direction, when we know 80 odd % of women can be normal, then why use the experts in the abnormal!!! Yes the amazing medical lobby comes in here, but things are in such a state I believe we can start to be effective.

Also the line re VBAC is total bollocks (I know you know this), you need to hit them straight back with examples like the following

We know there is between a 1-2% chance of spontaneous abortion after amniocentesis, however this test is offered routinely to a group of pregnant women.  What has been determined here is a cost benefit analysis, a 1% chance of miscarriage to determine foetal abnormality in a group of women with a greater danger of such.  The benefit (certainly in their eyes not mine!!) outweighs the risk.  I would certainly say that the 0.2% risk of uterine rupture far outweighs the danger of a repeat c/s!!!

Hope it helps

In solidarity

Justine


-the problem that we are facing is that the 1% (which in fact according to the most recent Australian study is in fact 0.2%) chance of rupture is seen as too high a risk for insurance companies.  It is this reason that places like Flinders Medical centre in SA is refusing vbac to the birth centre (until now women have been able to access the amazing support and understanding of some of the most wonderful midwives).  The formal reasons given to me by Flinders reads:

"...the Department Meeting when the decisions were made was that the increased safety provided to such women by birth in Labour and Delivery Suite under the care of an obstetric team and with continuous electronic fetal heart rate monitoring will outweigh other concerns..."

It goes on to say if the situation arises where a woman states she will take full responsibility for any adverse outcome which occur as a result of her decision, such undertakings can not be binding to that woman at a later date.

This situation and the proposal to increase the insurance of those who practice 'riskier procedures' such as vbac is blatant manipulation by lawyers and insurance companies of medical care providers.  they are being held almost at ransom (and I am not just referring to obs, it included mw as we all know).

I am battling a head ache at the moment so I cant really go into this too much, but is there any mw or associate who is well versed in the medico-legal issues that can shed any light on this?
Jo Bainbridge
founding member CARES SA
email: [EMAIL PROTECTED]
phone: 08 8388 6918
birth with trust, faith & love...
----- Original Message -----

From: Lynne Staff <mailto:[EMAIL PROTECTED]>  
To: [EMAIL PROTECTED]
Sent: Wednesday, November 06, 2002 10:38 AM
Subject: Re: [ozmidwifery] axa

What you have done with this email Justine, is to very nicely and succinctly put 'risk' in perspective - something that not many do regarding uterine rupture.
----- Original Message -----

From: Justine Caines <mailto:[EMAIL PROTECTED]>  
To: OzMid List <mailto:[EMAIL PROTECTED]>  
Sent: Sunday, November 03, 2002 10:58 PM
Subject: Re: [ozmidwifery] axa

Hey Jo

Love reading your posts, you have the right idea!!

Why would VBAC be seen as riskier?  I would think a 1% chance of uterine rupture would be preferable ‘risk’ to a c/s anyway?  Then again evidence doesn’t play much of a role does it!

Take care

Justine



I have often thought that those who want elective cs for no medical reasoning then it should be considered 'cosmetic' and should be treated like cosmetic surgery....YOU pay!  Perhaps the cover should be more costly for those who elect surgery?  The argument that cases of FTP and CPD would increase: but that would be obvious and the medicos would have  allot of explaining to do to justify it.  
There will always be loop holes for women and doctors to get their sections, but it could be a deterrent.  Elective CS cost insurance companies thousands of possibly unnecessary dollars.  It should be structured like car insurance: those who live in high crime areas have to pay more- therefore those who elect unnecessary surgery should pay more.  
There should be a strict criteria which allows emergency cs as exempt from charges.  As I said before the chances are the 'emerg' cases will increase but they are leaving themselves open for close scrutiny.....
What concerns me about insurance companies power over care is that there are reports that doctors who are 'allowing' vbac will be facing higher insurance costs due to the increase risks.........call me biased but THAT IS CAUSE FOR CONCERN!!!!!
well,  there is my 5c worth (about all I have got!)
Jo Bainbridge
founding member CARES SA
email: [EMAIL PROTECTED]
phone: 08 8388 6918
birth with trust, faith & love...