Based on this, expect US hospital prices for that service to go up.
You can get much better service for way less money if you avoid the red tape and do a home birth.
They’ve all gone well for us, so I recommend them from that point of view, but on the other hand, I don’t recommend them because I’d hate to have any hand in a situation that went wrong for someone else.
Our last we actually delivered on our own because the midwifes didn’t get to us in time.
Birth - a natural process - has been commercially medicalised, especially in Brasil (C-section rate >60%) and the US (>30%). If giving birth at home was normalised, we'd see a huge growth in natural birth and an increased availability for medical staff to support in emergencies if required. But the rates of emergencies would actually decline too.
Otherwise I think it’s an awesome idea and encourage people to consider it.
Birthing centers are also a great alternative. I do not especially like the idea of hospitals as default places of birth, but acknowledge the potential value when needed.
My wife had unexpected complications that would have been disastrous, possibly fatal if we had been at home rather than a hospital for delivery. I can’t imagine trying to rush her from home to the hospital mid-delivery.
I’m forever grateful for the medical care we received at the hospital during delivery. It’s simply not possible to deliver the same care at home.
“During a caesarean, many people become shaky, nauseous, uncomfortable, even faint,” Grant explained. “These are normal physiological reactions. In order to facilitate skin to skin in the OR, an extra nurse needs to be available to assist.”https://www.vox.com/2016/10/4/13160624/medical-bills-birth-d...
"Skin to Skin after C-Sec" $39.95
[C-Sec here means Caesarean section, a relatively safe surgical procedure to delivery a baby via an incision in the mother's abdomen. Although mostly safe, and certainly preferable to situations where vaginal delivery would incur an undue risk to mother or baby, C-Section is undesirable because it increases the rate of complications both that time, and in any subsequent pregnancy. But it's very common in the US, for a variety of reasons.]
how long until they try to give everyone the best service according to their budget. one arm holding 30$, two arms 40$, full cuddle 70$
More generally: declining birth rates are one of our top-ten societal problems if we think 50-100 years ahead; part of addressing it is changing the conversation around pregnancy in one's late 30s and even early 40s. From watching TV shows it would seem by age 35 your shot is shot.
In our case, the hospital my wife delivered in pushed skin to skin heavily, but after a minute or two, I ended up holding our son, skin to skin for the next 10-15 minutes becuase their policy didn’t allow mom to hold the baby while they sutured and did their thing. Once they were done in the OR, back to mom.
Usually this sort of absurdity on the billing front is based on ways to increase Medicaid reimbursements. Since Medicaid patients are usually less likely to have good primary and pre-natal care, they have a high complication rate and typically are a money loser for the hospital. In an extreme case, an opioid addicted baby costs >$1M to deliver and discharge, a tragic story all around.
We had a pediatrician in the room (which is also a perfectly opportunistic for the ob/gyn to score a referral). OR theater was main OB/GYN (which we chose), his assistant (also ob/gyn, younger and oddly published), anesthesiologist, instruments clerk and pediatrician. I don't think we had a nurse at all.
If you're not getting a c-section, the usual array is: OB/GYN, plus or minus a resident or assistant, doing the delivery and doing any post-delivery laceration repairs; and a nurse who brought in instruments and is on hand to assist with repositioning the mother, getting more equipment, etc. In most places it's 1-2 nurses. If everything is expected to be, and remains, stable a pediatrician will swing by at some point to check in. This isn't generally a major source of referrals for the pediatrician - (a) many people have already established a relationship with a pediatrician in anticipation of the birth, and (b) in many reasonably sized hospitals the guy who drops by is either a hospitalist or a neonatologist, and they don't have an outpatient practice. Anesthesiologist may drop by to start an epidural, but otherwise isn't present on a continued basis.
If in the OR for a c-section, you'll have the OB and a resident or an assist; one nurse just looking after scrub and tools; a second nurse on hand for additional assistance and to receive the kid for the initial clean-up; an anesthesiologist handling your anesthesia; plus/minus a med student or two either holding instruments for the OB or speaking with the anesthesiologist. If everything is and remains stable, peds will swing by. If the kid is unstable or things go sideways, peds +/- their resident will be on hand for the delivery - a neonatologist if the hospital has one.
I've seen some variation in different places of course, but that's pretty much par for the course.
(When I was in the latter part of med school I had a brief fling thinking I'd do OB/GYN, so I did sub-I's in a few different hospitals around the country. Thank god that idea passed.)
Why's that? Just curious, I always find it fascinating how physicians pick a speciality!
1. A good subset of patients have wildly unrealistic ideas about pregnancy and delivery, and when their ideas meet reality it's not always reality that wins.
1.B. You will be the target of their ire whenever their desires are not fulfilled, because patients seem to think docs are actually in charge of something at the hospital. We usually are not.
2. It's wildly litigious. Their child was perfect (in their imagination) before being born; then you got involved, and now their child is not perfect. You must have fucked something up in the delivery and ruined the perfection of their child.
3. Way too much family involvement. When you're doing surgery, you're usually dealing with a patient's attempts to understand what's going on. When you're doing OB, you're dealing with the patient, the husband, the mother, mother-in-law, etc. Each person will come up with their own distorted vision of how things should be, and when it doesn't align with reality, the doctor is an idiot who doesn't know what they're doing. (Doctors are not perfect - just people - but it seems like every single person without medical training seems better equipped to identify the proper medical course of action than a physician is.)
4. Lots and lots of on-call time. Lots of unexpected interruptions and lots of drop-everything-and-drive-to-the-hospital.
5. There used to be good money in it. There isn't now, which makes all of the above grate on one's nerves.
The results of the above really add up to demolishing the spirit of OB/GYNs. Points 1-3 really make you feel like you're persistently at war with patients, which is the worst feeling ever. I've never been on anyone's side but the patient's, and having them treat me like an enemy ruins my job, and ruins my ability to do my job.
I ultimately chose to pursue a niche thing that shares a name with an existing medical specialty, but is a distinct niche. I can't really identify it without doxing myself, so forgive me for not.
Can you clarify what you are implying here? Kickbacks or other financial incentives are generally pretty illegal.
The wealthiest country in the world cannot even pay for the birth of its own citizens?
I can understand arguments for private healthcare etc....but making people pay to give birth is insane.
No? I certainly don't. I'm constantly aware of how much we don't spend on roads.
Any conversation trashing the US for not having healthcare that is free-at-point-of-sale is meaningless without discussing the larger system.
What can I say, I get tired of Europeans trashing the US using singular metrics as if they're a meaningful reflection of policy.
You want to get into a more interesting conversation, let's talk about how the US citizenry is essentially subsidizing the universal healthcare that many other countries enjoy. That's not some political talking point, either, it's legitimate.
Let me ask this then - is there anything in the world you would call free, or do you avoid the word out of principle?
>>Any conversation trashing the US for not having healthcare that is free-at-point-of-sale is meaningless without discussing the larger system.
I think you are purposefully trying to drag me into a discussion about a point I didn't make, I merely expressed surprise at the fact that United States of America, the wealthiest nation in the world, cannot even pay for the births of its own citizens. No statement anywhere about healthcare as such. If you want to read into it in my comment, then that's on you.
>>You want to get into a more interesting conversation, let's talk about how the US citizenry is essentially subsidizing the universal healthcare that many other countries enjoy.
Let's have that discussion then, please, I'm curious to hear your thoughts.
Ideally, roads are that way too. People licensed should be charged a tax for road maintenance based on their odometer readings, or something to that effect. Or just use a Fastrak-type system where it automatically scans a device in your car when you get onto certain roads and charges you for that usage -- but do it in more places.
Everyone else can get a very minimal tax for the upkeep of the administration in case few very people use these services.
Medical Debt Up => Poverty Up => Crime Up => Incarceration Up => Paying for their imprisonment instead.
You're protected by prisons, so you are a user of the service provided by them and must therefore pay under your model.
> Ideally, roads are that way too.
How would this work for e.g. Montana with seemingly-endless lengths of highway and a very low population density?
…
Let's take things a little further. Do you believe only private schools should exist?
Why would they need nice roads then? Seems like a waste of money to build a bunch of expensive roads for the 5,000 people who use them. They can manage with cheap roads and dirt roads that don't need much maintenance. The Chinese rural areas manage just fine with dirt roads, and those areas have way higher population densities.
>You're protected by prisons, so you are a user of the service provided by them and must therefore pay under your model.
Why should I pay for someone's crimes? It's such a stupid system. If they are murderers they should just receive the capital punishment. And if the crime is not murder, they can be put into factories where they are able produce something of value -- farming or whatever. If their business is not profitable it should at least reduce the taxpayer burden. I know this is dreamland ideal world logic, but working closer to this certainly doesn't hurt, with the alternative being they don't do anything at all and are pure leeches. Yes, I know they make license plates but surely they can do a little more than that with such a huge prison population. This also incentivizes training them and providing them skills when they leave prison -- if training them with skills will help the prison make money, why not? The inmate also leaves the prison with job prospects with many years of experience in a trade.
>Do you believe only private schools should exist?
Private schools have higher success rate for their graduates. There are other factors that play into this, obviously. Let me ask you this first - do you think public schools are doing poor kids any good? Especially in the inner cities where many poor black families live? I think any alternative is worth looking into to bring them out of poverty. Or you can just leave them to their devices.
God, I would hate to live in the system you're describing.
And again, it's all me me me. Society wants to punish people with prison, so society should pay for it. Whether you personally want to is fortunately irrelevant.
As for forcing people to work so they are not a burden on society - that's just slavery with extra steps. But oh wait, I forgot that US still does that. Nevermind then.
>>if training them with skills will help the prison make money, why not?
Because prisons should never ever ever be money making institutions in a functional society. I can't believe I actually have to say this.
>>Let me ask you this first - do you think public schools are doing poor kids any good? Especially in the inner cities where many poor black families live?
Of course they do, what are you on about.
That the private prisons wouldn't lobby to make all speeding illegal in order to increase the labor pool for profit.
That they'll hear about the law change in time.
That they'll never have to drive 5mph above the speed limit because they're running late.
That they'll never be one of the slaves in the cyberpunk dystopia they're longing for.
This is just a difference in our morality I guess. I don't think prison should be a great place to live. They should be incentivized to leave prison. And they aren't treated as slaves, they are learning a trade and applying those skills. They should be paid a lower wage, have the option to send money to their families, and fund the prisons themselves to some degree. We already this to a lesser degree. Prisons just aren't doing this enough.
>Because prisons should never ever ever be money making institutions in a functional society. I can't believe I actually have to say this.
I don't understand why prisons should not make money. Why does there be distinctions for things that should or shouldn't make money? For things to function well, they need to be decently funded. Whether that's from you and me or them funding themselves.
>Of course they do, what are you on about.
Okay, then I guess we live in different realities if you think black kids are doing well in inner city public schools.
No one said prisons should be nice. Just that we have empirical data which prison systems support rehabilitation and reintegration into society and which ones don't. American prisons aren't on the first list. They are disproportionately about revenge and retribution, which leads to low rehabilitation rates.
>>They should be incentivized to leave prison
Let me get this straight - you think current prison system doesn't incentivize leaving prison enough?
>>I don't understand why prisons should not make money. Why does there be distinctions for things that should or shouldn't make money?
Because it creates a whole lot of perverse incentives that simply shouldn't exist around the prison system. Incentives to both keep people longer than necessary in prisons as well as put them in prisons in the first place if they are places to make money. And it's not just a made up fear - there have been judges in the US found to be doing exactly this, taking cash bribes to send people to for-profit prisons. That profit making incentives shouldn't exist. Just like schools shouldn't be making profit, just like hospitals shouldn't be making profits - they are utilities for the society, not profit centres. Or at least in a well adjusted society they shouldn't be. As soon as you introduce profit the incentives shift where they shouldn't.
>>Okay, then I guess we live in different realities if you think black kids are doing well in inner city public schools.
That wasn't your question though. You asked if public schools are doing black kids in inner cities any good. To which my answer is still the same - of course they do. If you'd like to ask your question again I'll answer it again.
Yes, it doesn't. Many have nothing to look forward to outside of prison. I hate to use a movie as an example, but take a look at Shawshank Redemption. They should leave having gained something, maybe prisons can help inmates find employment for the skills they gained as they reach the end of their sentence.
>Because it creates a whole lot of perverse incentives that simply shouldn't exist around the prison system.
I view nothing as immune to corruption. It's just a matter of better alternatives. Ideally inmates are allocated more to prisons with high rates of success after serving their sentence, which gives prisons an incentive to get their inmates out and with marketable skills.
>taking cash bribes to send people to for-profit prisons
This is not exclusive to for-profit prisons. Prisons that have higher number of inmates can make an argument for a higher allocation of tax dollars.
>Just like schools shouldn't be making profit, just like hospitals shouldn't be making profits - they are utilities for the society, not profit centres
You've said this more than once, but I still don't see why they shouldn't be. All I hear is "they just shouldn't make money". Why? They're just going to play games to get more tax dollars if they're forced not to make any money themselves. Bad schools are allocated more funds, take the LA Unified School District for example -- some of the worse performing schools in the nation, yet some of the best funded public schools! If I'm pessimistic enough, I would even imagine the teachers and administration are not doing their job on purpose.
Hmmmm. I think the issue here is that you're looking at it from an individualism perspective. Why should I be paying for something that I'm not using. You're obviously completely entitled to such an opinion, and I'm not going to change it with one HN comment, but imho that's the wrong way to build a society. Society should be paying to support new births, because those people will eventually grow up to be the workforce of your country, they will be paying taxes, and supporting you in retirement. The individualist approach that I see so often in Americans just seems so short sighted to me - why should I pay for any of this. I don't care about any of those things, if people want workforce/taxes/retirement they should just work for it goddamit!
Like, ok. I just want to point out that societies, including American one, pay for things just because they want to have them, regardless of whether it benefits every individual or not. You pay for roads just so they are there and so that every American can use them, regardless of whether you personally are going to drive every mile of every road ever built. Most Americans want to pay for agencies that make sure you have clean water or air, even though personally you probably aren't going to live in Flint or next to a coal power station. And obviously all Americans pay for the biggest military in the world just to keep a certain level of control and place in the world, even though many people could say well, how does paying for the 20th aircraft carrier benefit ME?
Paying for people to give birth so that they don't end up in medical debt straight away when starting a family has benefits to the society. But you will never see it if you just try to see what's in it for you personally.
I view it as an optimization problem. Given a set number of tax dollars collected, everyone wants a piece of it. I don't trust people to allocate these correctly. The alternative is to give less of these dollars so less corruption and mistakes can occur, which is what I view is better.
As for using the next generation to support the older generation through taxation, this does not seem to work very well in practice. As societies reach higher quality of life, like in the US, Japan, some Euro countries, there tends to be a drop in birth rates. There are other factors in play (career opportunities, culture), as in some of these countries giving birth is highly encouraged (e.g. Japan pays families to give birth). I just view it as risky to expect there to be enough children to support all the old folks. They might even vote those benefits out and you'll be left hanging.
For example, if we're going to mandate something, rather than Social Security a mandatory 401k-style plan seems better. That account is yours, it's your own money, and the government just asks you to deposit 5-10% of every paycheck into that account and you can withdraw a fraction of that account with some interval once you're 50. Maybe it can used to pay for health care before 50.
I live in the UK, which has quite a generous benefits system. Although such a system is open to abuse, it's much cheaper than imprisoning people that have resorted to crime to get by (they they do in the US).
The problem is you have to apply for it. Maybe people should be automatically enrolled.
Most US citizens have babies in hospitals.
Many either don't know that alternative options exist or think of them as dangerous / an unnecessary risk.
And this was at Major CT Hospital.
1. https://www.cbsnews.com/news/doula-explains-why-hospital-cha...
Edit: I'm agreeing with you but it seems absurd that it should have to be opinion!