{"items": [{"author": "Alice", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634644325562", "anchor": "fb-634644325562", "service": "fb", "text": "Hey, I actually agree with you!", "timestamp": "1383678923"}, {"author": "Gianna", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634644689832", "anchor": "fb-634644689832", "service": "fb", "text": "Our doula was invaluable. Although I did end up with a c section in the end, without her I don't think we would have been successful in early breastfeeding, and that is beneficial for baby's health so presumably also a money saver (though not sure of the magnitude)", "timestamp": "1383679169"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634657020122", "anchor": "fb-634657020122", "service": "fb", "text": "During the births of our daughters, we became highly radicalized about the US birthing industry. For all the money spent in the US, we're WAY back in the pack in neonatal outcomes. Doulas are the single most effective improvement in the process. Corollary: God's (or nature's, your choice) c-section rate is down around 5%. This percentage of births really do need the procedure. The current US rate is nearer to 25%, which is a simple measure of how births are botched up by our poor medical practice.", "timestamp": "1383686671"}, {"author": "Jeannine", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634674754582", "anchor": "fb-634674754582", "service": "fb", "text": "I love how you support your theories with evidence!", "timestamp": "1383695275"}, {"author": "Pamzella", "source_link": "http://www.reddit.com/r/pregnant/comments/1pyvmo#cd7qbg6", "anchor": "r-cd7qbg6", "service": "r", "text": "Interesting! Having had friends lucky enough to have one, I would love to see it become a more common practice.\n", "timestamp": 1383702952}, {"author": "David Chudzicki", "source_link": "https://plus.google.com/106120852580068301475", "anchor": "gp-1383719489756", "service": "gp", "text": "To know if insurers would be better off paying for doulas, I think you'd have to know how many additional doulas they'd pay for that would have been hired anyway vs. how many additional doulas would be hired that wouldn't have been. (And those numbers could change over time. Maybe initially they'd mostly be paying for doulas with no benefit, but eventually doulas catch on and most people using doulas wouldn't have otherwise.)", "timestamp": 1383719489}, {"author": "Rick", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634726396092", "anchor": "fb-634726396092", "service": "fb", "text": "I totally support your main points, that insurers should pay for doulas, and that doulas reduce C-sections, improve the health of the baby and mother, and reduce costs. However, I do think there is a fallacy in your logic: I think it's very likely that women who choose to have a doula are much less likely to have a c-section anyway than women who don't because they generally value \"natural childbirth\", and would advocate for this anyway.", "timestamp": "1383734543"}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1383750664462", "service": "gp", "text": "@David Chudzicki\n\u00a0\"you'd have to know how many additional doulas they'd pay for that would have been hired anyway vs. how many additional doulas would be hired that wouldn't have been\"\n
\n
\nRight.\u00a0\u00a0At a cost of $700 for every doula and a savings of $1100 per marginal doula, the insurers lose money if more than 36% of the doulas hired would have been hired anyway.\u00a0\u00a0 Doulas attend just a few percent of births currently, though, and I would expect providing them free and advocating their use could triple that.", "timestamp": 1383750664}, {"author": "Heather", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634763556622", "anchor": "fb-634763556622", "service": "fb", "text": "Great ideas and information here. I'm going to slightly disagree with Richard's comment on your logic. I didn't have a doula or any real interest in one, nor did I have any interest in \"natural\" (whatever) childbirth, but I did NOT want to have a c-section. There was pressure from the doctor to have one after 23 hours of labor, and if it wasn't for the fact that my husband and I really pushed back - hard, we may have ended up with one. So in cases where the woman/couple might need an advocate or someone to help them make decisions, having a doula would be an invaluable resource in having that voice to help you advocate for what you truly want. Yes those who have a doula might have made their feelings on c-sections known early in the process and perhaps louder, but in my experience I haven't actually met a woman yet who \"wanted\" to have a c-section - but I have met plenty who felt they were pressured into them in the moment. At those moments a doula could definitely reduce the chance of having a non-medically necessary c-section.", "timestamp": "1383761852"}, {"author": "Heather", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634763905922", "anchor": "fb-634763905922", "service": "fb", "text": "I neglected to say that if a doula had been covered by insurance we may have considered using one :)", "timestamp": "1383762035"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634774858972", "anchor": "fb-634774858972", "service": "fb", "text": "@Richard: \"women who choose to have a doula are much less likely to have a c-section anyway than women who don't\"
The study I talk about is one in which women who weren't planning on having a doula are randomly either assigned one or not. Now, it could be that if insurance companies started covering doulas the main people who would take advantage of the change would be people who were either already going to have a doula (as David) points out on g+) or who were already at reduced risk for c-section for other reasons as you say. But I think the main reason people don't usually have doulas with them for births is that it's expensive to have one and people don't know the benefits. If insurance companies covered doulas we could move from \"doulas are an expensive luxury\" to \"doulas are beneficial to you, your baby, are recommended, and are entirely covered by insurance\". This should give enough of a change in the demographics of which people have doulas that we would see results like the random-assignment study.
One way to measure this would be to hold a modified version of that randomized controlled trial. Randomly assign expecting mothers to two groups: in the control group you make no changes, which does mean a few will bring doulas, probably around 2%. In the treatment group you tell people at a prenatal visit that doulas lead to better outcomes for both the mother and baby and that if they wish they may have a doula attend their birth for free. Compare total costs to the insurers between the two groups.", "timestamp": "1383768072"}, {"author": "Melissa", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634775687312", "anchor": "fb-634775687312", "service": "fb", "text": "I think being informed can help a lot. In my case, the doctor started mentioning going with a c-section when there was absolutely no medical reason for one to happen. I refused and my guy was born 20 minutes later. I remained calm, and my husband was a rock during the whole delivery. A doula is great if one can be afforded. In the absence of one, it's possible to to be your own advocate, or to have your spouse play that role. I could tell the doctor who delivered my child was in a rush, but I refused to let that affect the birth. They can't do something a patient refuses, and I knew that. So be informed, be prepared to be flexible (sometimes there IS a medical reason to have a c-section), and enjoy the process! Congrats, by the way, I'm so happy for you guys!!", "timestamp": "1383768702"}, {"author": "Daniel", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634776011662", "anchor": "fb-634776011662", "service": "fb", "text": "The real question here is why the hell it costs $18K for a natural vaginal birth.", "timestamp": "1383768894"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634791236152", "anchor": "fb-634791236152", "service": "fb", "text": "Daniel: probably because, without modern medicine, the risk of death in childbirth is about 1 in 10. That's not to say that it needs to be that expensive, but it's certainly not something that just works without a hitch all the time.", "timestamp": "1383777379"}, {"author": "Melissa", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634793162292", "anchor": "fb-634793162292", "service": "fb", "text": "http://www.cnbc.com/id/101055112", "timestamp": "1383777978"}, {"author": "Cory", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=634896086032", "anchor": "fb-634896086032", "service": "fb", "text": "Great discussion! I'm glad Richard brought up that point, so that Jeff had the chance to mention that the women were randomized into having a Doula or not, which makes this study very strong!", "timestamp": "1383841342"}, {"author": "Gianna", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635299931722", "anchor": "fb-635299931722", "service": "fb", "text": "In the \"personal experience\" category...we were adamant about NOT having a c-section all through our pregnancy and took a lot of care to prepare in ways that would reduce the likelihood of having one. What surprised me was that in spite of that, when you're in labor, and trying to weigh the risks and benefits, it is nearly impossible to know what the \"right\" choice is. I'm honestly not sure if we were \"pressured\" into our c-section (it did feel that way, a little) or if I would have been an idiot to keep trying to push the baby out. The problem is, everything's fine until it's not, and the stakes seem so high that at some point it seems foolish to keep trying. There were so many variables - I'm still not sure which of our doctors' reasons and recommendations I believe and which ones I'm skeptical of.", "timestamp": "1384199761"}, {"author": "Elizabeth", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635306538482", "anchor": "fb-635306538482", "service": "fb", "text": "$18k seems really high for vaginal birth though - my entire bill was under $5k.", "timestamp": "1384203534"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635307646262", "anchor": "fb-635307646262", "service": "fb", "text": "@Elizabeth: is $5k what you paid or what your insurance company paid?", "timestamp": "1384204346"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635309632282", "anchor": "fb-635309632282", "service": "fb", "text": "I'm currently shopping for insurance, and vaginal birth is actually one of the examples they give to compare plans, at a total cost of about $7,500 (that's the sum of what the insurance pays and what the consumer pays).", "timestamp": "1384205492"}, {"author": "Elizabeth", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635332087282", "anchor": "fb-635332087282", "service": "fb", "text": "Jeff - We have a deductible, so the bill came to me. It wasn't itemized so I can't tell you what was included, but we also had no complications for mom or newbor, no pain medication / epidural, delivered at a smaller hospital (Mt. Auburn) and left on the earlier side of things, which perhaps contributes.", "timestamp": "1384215257"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635351059262", "anchor": "fb-635351059262", "service": "fb", "text": "Maybe the $18k number comes from a few births with very expensive complications? Or maybe Truven's data isn't very good?", "timestamp": "1384227348"}, {"author": "Melissa", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635353379612", "anchor": "fb-635353379612", "service": "fb", "text": "The price difference could also depend on how much the hospital charges per night. My local hospital charges about $2500 per night for just the room. That doesn't include any medical treatment. I spent two nights in the hospital, so that's $5,000 right there. Maybe that's a Philly thing???", "timestamp": "1384228528"}, {"author": "Melissa", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=635353499372", "anchor": "fb-635353499372", "service": "fb", "text": "Oh wait, I spent three nights, now that I think about it! So that puts me at $7500 already! But I can't complain, we have awesome insurance and didn't really need to think about it as much as others need to.", "timestamp": "1384228624"}, {"author": "Allison", "source_link": "https://www.facebook.com/jefftk/posts/634643736742?comment_id=640137621952", "anchor": "fb-640137621952", "service": "fb", "text": "I just read something about insurers and Medicaid moving towards covering doulas. It's somewhat scattered, but: http://the-toast.net/.../birth-activism-class-access.../", "timestamp": "1386308168"}]}