Movie: "The Business of Being Born."

33-weeker · Feb 6, 2008

Then why are so many hospitals closing their L&D units?

Could the difference be the ratio of 'paying' vs. non-paying/medicaid patients?

I imagine that a hospital caring for mostly privately-insured patients probably turns a profit, where one with a majority of uninsured and medicaid patients struggles to keep the unit open.

The uninsured and limited PNC/medicaid babies also require more expensive testing and care on average - more preemies, more CBC & blood culture draws/+ 48 hr. stay for unknown GBS, + drug screens with extended boarder-baby stays while CPS places them, etc...

dawngloves, BSN, RN · Feb 6, 2008

Could the difference be the ratio of 'paying' vs. non-paying/medicaid patients?
I imagine that a hospital caring for mostly privately-insured patients probably turns a profit, where one with a majority of uninsured and medicaid patients struggles to keep the unit open.
The uninsured and limited PNC/medicaid babies also require more expensive testing and care on average - more preemies, more CBC & blood culture draws/+ 48 hr. stay for unknown GBS, + drug screens with extended boarder-baby stays while CPS places them, etc...

You would think. But I've seen hospitals in poor and upper middle class areas close their L&D. I think it boils down to how much they can get from the insurance companies for deliveries and how much Liability Insurance the hospital has to pay.

Jolie, BSN · Feb 6, 2008

Then why are so many hospitals closing their L&D units?

I'm going to show my age here.

Back in the late 1970's or early 1980's, there was a study that showed that couples who had positive experiences with the hospitals where they delivered their babies became extremely loyal to those hospitals, and continued to use the facilities for years to come, for adult med/surg needs, pediatric care, ER visits, even referring gram and gramps for orthopedic and heart surgeries, which were high-ticket items. Childbirth services have never been especially profitable, but the idea was to get the family's long-term repeat business for more lucrative services. This was the impetus for changes that took place in the 1980's in childbirth services, such as childbirth education classes, dads in the delivery room, posh L&D suites, cozy private PP rooms, special dinners for mom and dad, freebies, etc.

Problem is that our society and the insurance industry has changed. Families no longer remain in the same community long term, no longer live near gram and gramps, and no longer have free reign to choose their preferred hospital. But rather than address those issues, hospitals responded by competing for OB business by offering expensive and complex technology that was once available only at referral centers, such as infertility, high-risk OB, NICUs, 24-hour in-house medical coverage, etc. This duplication of services makes OB an extremely expensive service to provide, with diminishing returns, as patients may not be able to return to the hospital for subsequent services, regardless of how satisfied they were with their delivery experience.

I believe that the only alternative to closing OB services in smaller hospitals is to go back to the "old-fashioned" system of community hospitals referring high-risk patients out to designated peri-natal centers. Eliminating duplication of services would go a long way to lowering OB costs.

Belinda-wales, RN · Feb 6, 2008

There aren't many practicing Midwives because of the litigenous society we live in. The hospitals can't afford them and so many cannot afford to practice because of the cost of insurance. Does that need to change? Yes!
Do we need to stop the elective inductions and c/s? Yes!
Does all the blame lie on hospital CEOs? No.

Uk has a Litigenous society yet it still maintains a 70% + of maternity care is provided by midwives who are considered by everyone including the medical professions as the experts in the care of low risk the "normal" pregancies - becuase of this inductions are kept in the main to medical indecations only - and never to keep in with office hours which happens in the us all the time. Some of the smaller hospitals and midwifery run centers offer no epidurals-but the women always have a choice to attend hospitals that do- but many choose not to -birth is just viewed very differently - I could say that is because the care lead by midwives - but do not get me wrong there are many problems with the health care in the uk- but Ido not think that all of usa problems with maternity care is just down to the litigenous society - IMO a lot of the time pregnacy and birth are considered a problem that needs to be fixed-not made special to embrace and enjoy-just look at maternity leave and this really surprises me as the family is at the center of usa society -USA is an amazing place full of mixed messages all that said I am enjoying my bus mans holiday ( thats a british saying do you use it here). One day I mayget to practise midwifery here - :redpinkhe-that who be a dream come true.

SmilingBluEyes · Feb 6, 2008

I know for a fact, having seen a couple OB units close down in smallish hospitals their reasons had mostly to do with these problems:

*Money/revenue literally hemorrhaging through these units operating

*Insurance coverage/problems for the hospital that offers OB services

*Adequate and/or willing 24/7 anesthesia coverage NOT being offered.

I lost a job in one of those hospitals due to closure. They would rather make a lot of money having their day surgery clinic (which is where OB used to be) going, and who can blame them, really? It's a cash cow for this hospital/corporation.

dawngloves, BSN, RN · Feb 6, 2008

Uk has a Litigenous society yet it still maintains a 70% + of maternity care is provided by midwives .

Yes, it's because our society does not recognize midwives as much more than nurses with a fancy title. And when it gets to court the question will be, 'Where was the doctor?"

Ask any OB or OB nurse how much their Liability Insurance is and then ask someone in Medicine. Another reason L&D units are closing. They can't get the staff because no one can afford the insurance.

Since we are both sitting at home today, Belinda, let's have a little contest. See how many commercials for lawyers asking if your baby has Cerbral Palsy, Shoulder Dystocia or any other birth injury, you see on television. I've seen a half dozen. One office will even give your child a free computer!

33-weeker · Feb 7, 2008

I was made aware of something I never knew. I work at a facility with a level II nursery, but we of course stabalize smaller/sicker babies for transfer (lines, vent...) and occasionally keep a short-term vent or two. But because we are not designated to have any level III beds, we cannot charge level III charges, even when we are doing level III procedures (lines, vent...) ... then to top that off... apparently when a baby gets transferred downtown, the insurance only pays that facility, not us. Dumb, huh. Naive me thought we'd actually get paid for what we did and for the equipment used regardless.

We are currently working on getting level III status so we can charge level III charges.

Belinda-wales, RN · Feb 7, 2008

Yes, it's because our society does not recognize midwives as much more than nurses with a fancy title. And when it gets to court the question will be, 'Where was the doctor?"

How strange that CRNA, NNP or NP are not seen in th same light - when they recieve the same amount of education.

As for the tv ads well I do not watch much TV but I did to day and I guess you win Dawnglove not one TV add for birth injury although hundreds for DUI- and as a Clinical manager in L&D I have chosen to not to take extra insurance - I am happy with the vacarius (? Spelling) liabilty insurance offer by the company I work for.

I think that liabilty is often used in the USA for justification of practise when in reality edvidence based holistic care is the best defence and protection a practioner can get whether that be a doctor,midwife or nurse.

Jolie, BSN · Feb 7, 2008

I was made aware of something I never knew. I work at a facility with a level II nursery, but we of course stabalize smaller/sicker babies for transfer (lines, vent...) and occasionally keep a short-term vent or two. But because we are not designated to have any level III beds, we cannot charge level III charges, even when we are doing level III procedures (lines, vent...) ... then to top that off... apparently when a baby gets transferred downtown, the insurance only pays that facility, not us. Dumb, huh. Naive me thought we'd actually get paid for what we did and for the equipment used regardless.
We are currently working on getting level III status so we can charge level III charges.

An excellent example of the expensive lengths to which short-sighted administrators have gone to bring in maternity business that is largely unprofitable.

queenjean · Feb 7, 2008

I appreciate this documentary bringing to light the complexities of pregnancy/birth care in our society. No matter where you are on the fence (homebirth, hospital birth or in between) there are huge issues with insurance, the AMA, evidence based vs "because we've always done it this way" practice, hospital protocols vs individualized care, litigation, yadda yadda. I think that people outside of the birthing field have no idea the hoops and crap that we have to deal with on a daily basis that really has little to do with birthing but everything to do with "what if this person sues us? What if there is litigation? Have I followed protocol? (Not, have I provided the best care possible for the pt?)"

Also, let's all recognize that there is more than one way to birth in this country. Just like one educational philosophyand system does not work for everyone, neither does one birthing philosophy and system. I am a home birth/birth center birth all the way person, but I would never advocate for the closing of hospital birth units or for the denial of payment for things like elective sections. Choice choice choice. What is safest for one person isn't safest for the next, and I feel that women and their providers need to be the ones to make that decision.

Any media that brings thoughtful points and insights to the public at large is welcome in my book.

dawngloves, BSN, RN · Feb 8, 2008

I think that liabilty is often used in the USA for justification of practise when in reality edvidence based holistic care is the best defence and protection a practioner can get whether that be a doctor,midwife or nurse.

Now you're thinking like an American lawyer!

Belinda-wales, RN · Feb 9, 2008

Now you're thinking like an American lawyer!

LOL:yawn: