Tomorrow the AMA (American Medical Association) is voting on a resolution at their annual meeting that would create new insurance billing codes. These codes would allow care providers to categorize any disagreement or exercise of autonomy on the part of the patient as “non-compliance,” “abuse” or “hostility,” effectively creating a pathway for insurance companies to deny coverage to patients.

So what does this have to do with healthy low-risk pregnant mothers?  Well, a lot actually.  Let’s say that this healthy low-risk mom finds herself and her baby still healthy and low-risk but she is now 41 weeks pregnant and her provider is recommending an induction.  Not an uncommon scenario. She is not ready to depart from the natural process at this point and expresses that she is not comfortable going in for the induction.  Should this resolution pass, her provider could now threaten to deny her insurance coverage by classifying her as non-compliant or hostile.

I am assuming she is an average expecting mother who does not have an extra $5,000  to $15,ooo laying around just in case she is denied the health care coverage she pays for monthly.  This being the case,  her choices are now:  one, showing up at the appointed hour for her cocktail of artificial hormones that she does not want,   or two, letting labor unfold on its own and facing  major hospital bills, an insurance battle, and oh, that’s right, adjusting to her new life caring for a newborn.

Whatever happened to Informed Consent?  This is where the care provider makes a recommendation for the patient, explains the risks and benefits of the procedure and allows the patient to make the decision that she feels most comfortable with.  The patient is the one who has to live with the consequences of any decision made about her care, so she and her partner should be the one to make the final call.

Already as a childbirth educator I know of situations where a mother has arrived at her hospital in early labor.  Once she finds out that she’s only 3cm, she wishes to return home and come back later when she’s farther along in active labor.  This is where the care providers in the hospital tell her that that’s fine, but she’ll have to sign out AMA (against medical advice)  and it’s most likely that her insurance won’t cover her visit.  So, the mom now chooses to stay to avoid an huge insurance hassle and faces the likelihood of many more interventions simply becasue she’s in the hospital longer than she intended.

This has major implications for birthing women, but I will say for all of us as well.  So here is a list of questions for informed consent that I give every couple in my classes:

Informed Consent Questions

•  Is Mom OK?  Is Baby OK?

•  Is this an emergency or do we have time to talk?

•  What are the benefits of doing this procedure?

•  If we do this, what other procedures or treatments might we end up needing as a result?

•  What else could we try first or instead?

•  What would happen if we waited and hour or two before doing this?

•  What would happen if we did not do it at all?

If this passes it will be all the more important for women to make sure that they and their providers share the same perspective on childbirth.