After giving birth, the small sting that hurt the most

My second miscarriage started in a Starbucks bathroom, and I couldn’t have felt more alone. Where to go from there? I drove home, took as much ibuprofen as I could stomach, and resolved to quit my stressful teaching job.

I found a new position at a nonprofit, training writers to teach in public schools. My husband, who’d always been an entrepreneur, continued to lead a startup that encouraged girls to dream big. Our jobs provided no health insurance, but we weren’t letting go of our aspirations. We looked at individual plans. The best was worse than bad. In Texas only $2,000 could be allocated toward expenses for a first child. I opted for COBRA coverage even as my premium went from $500 to $600 a month.

I could be insured for 18 months. We kept trying. I was diagnosed with antiphospholipid syndrome, a disorder in which the immune system mistakenly produces antibodies against normal proteins in the blood. The syndrome caused blood clots, and, for reasons unclear, pregnancy complications such as miscarriages and stillbirths. The outlook didn’t seem good.

One night in May, I woke at 2 a.m. and anxiously counted off days. It was too late. Our coverage would run out. We stopped trying. We went to a wedding in Dallas, and I indulged in more than one margarita. Feet dangling in a pool, I felt the freest I’d felt in a long, long time.

Of course I was pregnant. But I’d learned not to hope. Even as week five turned into weeks six and seven, we called the cells growing inside me “Maybe.” I reeled with nausea at the smell of barbecue and slept for fourteen hours a night, but we wondered if the pregnancy would stick.

It stuck. We went to see a specialist who found my blood work inconclusive. Instead of getting heparin injections, I could try a baby aspirin everyday. She monitored the pregnancy, and, with each visit, the ground beneath us felt surer.

I tried to push away worries about how we’d pay. But there was my due date: February 6th. My coverage would run out midnight, January 31st. We set out to educate ourselves on natural childbirth: we practiced positions, monitored my diet, and learned what questions to ask.

During the holidays, we wanted only to rest, and, in defiance of our financial situation, treated ourselves to a night at a posh downtown hotel. Everything sparkled. The glass was so clean that my husband slammed his face into a door on the way out. January 31st was like that door. The barrier was invisible, but everything changed on the other side.

On the morning of February 6th, at a routine monitoring, the tech went silent. My amniotic fluid had dropped to a two; normal was an eight. At the hospital I was to be given Cytotec, which we knew as an intense cervical softener unapproved by the FDA. Our doula had warned us not to accept it. Our doctor told us it was this or a C-section. And we knew what a C-section cost.

Morning rolled around and I still wasn’t dilated. Minute by minute, contraction by contraction, the hours passed. I threw up. I screamed. I slept for thirty seconds at a time, and awoke to waves of pain. Then, something shifted, and transition hit. She was in my arms: Eliana Hope. I could barely lift all six pounds seven ounces of her.

In the end we paid close to $20,000 out-of-pocket. When I asked for an itemized bill, I found we’d been charged $8 apiece for two ibuprofen I’d been so kindly offered. That small sting somehow hurt most. I thought of the nurse who held my hand through transition, the nurse who ran water in the sink until I relearned how to pee, who steadied me when my coltish legs wobbled. And I felt betrayed. My joy at becoming a parent was tainted with righteous anger. The real pregnancy complication, as it turned out, had little to do with a blood disorder, and everything to do with a system gone wrong.

Laurie Filipelli is a writer.

After giving birth, the small sting that hurt the most

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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  • Lisa

    I understand the purpose for this blog, but it seems to me that most of the articles are somewhat outdated, with the advent of the ACA. For example, the young woman in this article would have been able to purchase insurance through the federal exchange. Her out of pocket costs would have been limited. It would be nice to see some real stories (ie not politically motivated misrepresentations ) of how the ACA is affecting medical costs for individuals.

    • John C. Key MD

      The joke will be on you, Lisa. Praising the hypothetical what-ifs of a failing system is not very convincing.

      • Lisa

        I don’t think the ACA is failing. It is not going to disappear. And if you are going to talk about controlling medical costs, as this blog does, it would be good to see the current reality reflected when you discuss costs.

        • John C. Key MD

          It is already clear that the ACA will not reduce costs or total healthcare dollars except through its rationing provisions. Some fees may be lowered or limited by decree but overall costs will not go down–just be shifted and paid by someone else.

          Regarding the reality of discussing costs, $20K for a complicated OB case isn’t that out of line by todays’ standards.

          You are right about one thing, though…the ACA isn’t going away, but it is definitely failing. Looking at one thing and calling it something else doesn’t make it true.

          • Lisa

            The ACA will reduce the amount individuals pay for insurance. If the woman in question had been able to purchase insurance through the ACA, her out of pocket costs would have been substantially less than $20,000. As one of the points of the story was that she couldn’t buy insurance after her cobra coverage expired, that is relavent. Nothing in the story addresses (other than the two $8 ibuprofen) the total cost.

  • ninguem

    What do you think of a doula who is discouraging the use of Cytotec in a complicated parturient with oligohydramnios, two spontaneous abortions, and (maybe) a hypercoagulable state?

    • Guest

      Typical?

      • guest

        Sorry for double post.

    • guest

      Ok, seriously though, the AFI is HIGHLY tech dependent and not a very reliable indicator of the actual amount of amniotic fluid. OBs can use this number to justify a rush to c/s even when it’s not necessarily indicated.

      • ninguem

        Seems to me, the OB wanted to avoid a section, that’s why the Cytotec.

    • guest

      Typical?

  • PrimaryCareDoc

    Complaining about the cost of the hospital stay, which saved the life of your child, while shelling out additional money for a useless doula who completely went out of her scope of practice by advising against Cytotec???

    Priorities, lady.

  • guest

    With all due respect, if you were completely determined to have a baby in the face of serious health issues, maybe it wasn’t such a good idea to quit your teaching job?

    We all have choices to make. You chose to quit a job which you felt was stressful, but provided benefits such as medical insurance. In making that choice, you took a risk that you would at some point incur uncovered medical expenses. Presumably you made that choice of your own free will, and after researching fully what the costs might be of an uncovered labor and delivery.

  • JR

    Thank you for sharing your story.

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