Back Alley Births

Research Supports Birth Choices as Insurance and Hospitals Limit Them

Most women's rights advocates know the phrase "back alley abortions."This phrase was popular before the passage of Roe v. Wade, when anti-abortion laws were not effectively reducing the number of abortions. Instead, the restrictions were, in effect, putting women's lives at risk by increasing unsafe abortions in "back alleys" or other unsanitary locations with no assistance from medical professionals.

Today, abortion is legal in every state. But today, a new problem has arisen as now birth is being highly restricted.

Birth advocates are trying to garner media attention regarding the rise of "back alley births." For a long time, insurance companies have deemed pregnancy a "pre-existing condition." For women who switch insurance mid-pregnancy, this switch can leave the pregnant women without the ability to pay for needed medical assistance during her labor. In June 2008, the New York Times reported that insurance companies are refusing to cover women with prior c-sections whether they are pregnant or not, leaving those women uninsured unless they submit to a hysterectomy surgery to remove their uterus.  See also the ICAN press release.

Even when pregnant women are able to obtain insurance, the insurance companies may limit the care they receive. For example, Kaiser refuses to compensate home births despite the fact that home births average costs less than $2000 and the typical cost for a cesarean birth (c-section) without complications can range between $14,000 and $25,000 or more! Just last fall, Aetna insurance announced that they also will not cover home births, and in addition, that they will not cover birth center births unless the birth center is attached to a hospital. Recently, Blue Cross Blue Shield made the only birth center in the Northern Virginia area an "out-of-network" provider, which will increase the costs to patients who choose to birth at home. These insurance companies are essentially limiting the women's right to choose to birth at home.

The problem, of course, lies in the fact that many women do not discover the restrictions by their health insurance company until it's too late. But, even for informed pregnant women who use a mother-friendly health insurance company, they may not be able to find a doctor to support them in their birth choices. In 2004, The International Cesarean Awareness Network (ICAN) exposed that over 300 hospitals in the United States completely ban Vaginal Birth After C-section (VBAC) even though VBACs are safer for most women than a repeat c-section. And, the entire state of Oklahoma has basically stopped giving pregnant women the option for a VBAC due to the medical malpractice insurance company , which will not cover doctors who offer VBACs to their patients.

With these multiple, severe restrictions on pregnant patients' established right to informed refusal, there is a clear violation of women's rights that we need to fight. But, in these cases, the injury goes significantly further than just the theoretical right. C-sections, while a life-saving surgery sometimes, are to blame for higher maternal and infant mortality rates, as well as long-term harm, like increased risk of infection and decreased breastfeeding rates besides countless other more minor dangers. Women who do not want to be subject to these restrictions - either because they underwent a painful c-section birth with their first child or were informed before their first birth - are often forced to seek a "back-alley birth." This means that they either have no assistance ("free birth") or they use an unlicensed midwife or a midwife practicing outside the scope of her license. These choices are more dangerous for high-risk women with previous c-sections than attempting a VBAC in a hospital setting.  For women who cannot find a provider who supports VBACs, however, this is their only choice.

Just last week, the Wall Street Journal reported that a study in the New England Journal of Medicine shows that one-third of c-sections are done too early, putting the mother and infant at increased risk. With more and more studies showing that hospital interventions are dangerous, while more insurance companies limit coverage of out-of-hospital births, more and more women will be left to do "back-alley births."