Tuesday, October 07, 2008

Making false claims and then wondering why no one takes you seriously

Here's a typical example of a homebirth advocates simply making up an utterly false claim, and passing it off as true. As far as I can tell, she made zero effort to establish the veracity of her claim. It seemed reasonable to her, and, in her mind, that was enough to qualify as "proof". Homebirth advocates wonder why no one takes them the least bit seriously and this is why. They prattle away without having any idea of what they are talking about.

According to Nicole D of Bellies and Babies:
Well, let's get straight to the point: hospitals make a lot of money from epidurals.
Actually, hospitals and anesthesiologists LOSE money on epidurals. Consider the paper How much labor is in a labor epidural? Manpower cost and reimbursement for an obstetric analgesia service in a teaching institution published in the journal Anesthesiology.
With intermittent staffing, labor cost was $325 per patient. Actual practice at Duke University Medical Center is around-the-clock (dedicated) staffing, which requires 4.4 FTEs at a cost of $728 per patient. Neither average indemnity reimbursement ($299) nor Medicaid reimbursement ($204) covered the cost per OAS patient. Breaking even is possible under indemnity reimbursement because operating room reimbursement subsidizes Obstetric Analgesia Service costs. Breaking even cannot occur with Medicaid reimbursement under any circumstances.

CONCLUSIONS: Obstetric analgesia services requires a minimum of 2.5 FTE attending anesthesiologists at Duke University Medical Center. With the current payer mix, positive-margin operating room activities associated with the obstetric service are not sufficient to compensate for the losses incurred by an OAS. Around-the-clock dedicated obstetric staffing (4.4 FTEs) cannot operate profitably under any reasonable circumstances at our institution.
This is only the most glaring of Nicole D's made up claims. She's wrong about the action of epidurals; she says they "cause your uterus to relax." Then after assembling a variety of made up claims, she proceeds to her utterly inane conclusion:
Now things begin to line up... why women are being refused VBACs because of hospital policy or individual practice, why a nurse refuses to adhere to one request out of many on her birth plan: that medication not be routinely offered, why the AMA refuses to acknowledge that home birth is as safe as hospital birth for low-risk women and why they are attempting to outlaw home birth all together, and why hospitals across the board are pushing for the 'safety' of medication in birth... profit.
Makes perfect sense to her, because she has no idea what she is talking about.

What's the real story? Epidurals are not profitable for anesthesiologists or hospitals. Except in large institutions, it is very difficult to cover the costs of 24 hours obstetric anesthesia. Therefore, hospitals are unable to offer VBACs because they can't afford to maintain the services necessary to offer them safely.

Nicole D throws in a few extra made up claims for good measure. No, Nicole, all the existing scientific evidence shows that homebirth is not as safe as hospital birth. No, there is no financial incentive in claiming that epidurals are "safe" since insurance companies reimburse less than the cost of the epidural and the anesthesiologist who must be available to administer it.

We have already seen that homebirth advocates live in Birth Fantasyland, pretending that birth is inherently safe, pretending that complications are rare, and pretending that thinking positive thoughts can affect the outcome of birth. Now it seems that Birth Fantasyland extends to the hospital, where homebirth advocates pretend that epidurals generate profit, in order to pretend that doctors and nurses offer pain relief for reasons other than relieving pain.

0 Old Comments: