Originally Posted by fourlittlebirds
Who is delivering these babies, then? Regardless of shortages, women still seem to be able to find doctors...
I'm an RN, and I once worked in an area of the country where this is happening, and in the particular city I worked in, the OBs were not accepting any patient who didn't have a solid insurance plan. No uninsured, no "self pay", no marginal medical deductible program plans, etc.
The uninsured people would present to the emergency department, where I worked, for their "prenatal care"... About every month or two, the women would present with a non-serious complaint (made up) - i.e., cough for two days, low back pain. Generally, as part of the evaluation for a pregnant woman, we would check blood pressure, do FHTs, and depending on the complaint, a urine dip. All most women wanted was to hear that "The baby's okay" and so was their throat and back. Most of the staff knew the situation and we would accommodate this; what else can you do?
Then, about halfway through their pregnancies, women would present to the ED complaining of severe abdominal pain or cramping/bleeding/tightness, etc. Part of that evaluation generally included a complete OB ultrasound, much like most American women get around 20 weeks. Upon completion of a typically normal ultrasound (where most found the gender of their babes), they would feel "better" and be able to be discharged home.
Then, when the women began to labor, they would again present to the ED. We would naturally triage them up to the OB unit, where whoever was on call would be called in to deliver their babies.
Post-delivery and post-hospital discharge, when the OBs again wouldn't see them without their insurance, they would present to the ED for evaluation of their lochia, perineal swelling, etc., and prescribe birth control when asked (which was frequently).
And, that, my friends, is, in a nutshell, why emergency department care costs so much.
It's a rotten system, and I can't blame the patients. It's all money-driven, and when you don't have the money, you don't get to make the choices.