Tragedy and Hope - Heartache, Death and Birth

At Victoria General Hospital right now there is a man who is waiting for a caesarean section, he waits because his wife, unlike every other mother-to-be is no longer able to wait as she is brain dead. She suffered a fatal cerebral hemorrhage on December 28, 2013. Her husband left to get her some Tylenol for a headache she had, and came home to find her unresponsive. He called 9-1-1, and while they were able to sustain her on life support, the damage was too severe and there is no hope for her recovery. She was 22 weeks pregnant at the time. She has been kept on life support since, in the hopes that her unborn son might be born safely at 35 weeks (in about 7-8 weeks time), or emergently if her body begins to fail her before then. Given his current gestational age – the baby already has an excellent chance of surviving the birth (80 percent).

The arrival of Iver Cohen Benson is expected to be bittersweet – a miracle born out of a terrible tragedy. Shortly after his arrival, his mother will take her final breaths and his father (Dylan Benson) will have to say his final farewells to the body of his life partner. He will embark on a new life then – the life of a new father, the life of a single parent, the life of a widower.

I applaud Mr. Benson for having the courage to take it on – he appears to determined to give his son the best life that he can. He has taken leave from his work to be at the side of his unborn son. After his arrival he will need to be by his son’s side for any required stay in the NICU, and after that the hard work will begin. The job of being both mother and father to a very small child while attempting to grieve and heal from a tremendous loss in his life.

Mr. Benson is going to need an incredible amount of support. Not just from his family and friends but also from his community. He is going to need all of the support he can get – all the support that most new mothers need, he will need. All the support that single parents need – he will need. All the support that widows/widowers need, he will need.

It warms my heart to see the outpouring of support that has begun for Mr. Benson and little Iver, but it needs to be understood that the support that has been given so far is just that. A start. This is the beginning of a very long (and potentially very expensive) road ahead, a road that will be navigated alone.

To give some idea about the costs of being a widowed parent to a newborn infant/toddler/pre-schooler think about the following :

1. If Mrs. Benson had survived, she would have received maternity/parental benefits and as a result of her employment (provincial government) her wages would have been topped up while she was on leave (up to 85% during 17 weeks of maternity leave and 75% while on parental leave) – and Mr. Benson would have been able to continue to work. After a year of leave if Mrs. Benson returned to work – she would have earned her income as well as being enabled to contribute to the daycare expenses of the child. If she chose to become a stay at home parent, daycare expenses would be avoided. In Victoria the costs of a full-time infant space is about $1150 per month – nannies are more expensive with live-in nannies costing about $1500 per month and live-outs costing $15 per hour.

2. If Mrs. Benson had survived, her family would have benefited from extended health benefits that she receives as a result of her employment. Unless Mr. Benson also has extended health benefits through his employment, those expenses will be out-of-pocket ones in the years to come.

3. If Mrs. Benson had survived, she may have chosen to breastfeed her son. Given her death and her son’s likely prematurity, he will likely need donor breastmilk. If you are in a position of donating breastmilk, please consider doing so to a breastmilk bank where donor milk is appropriately screened and pasteurized) – in BC information on doing so can be found at www.breastfeedingmatter.ca/html/milk-bank.html - babies like baby Iver benefit immensely from these donations. Eventually, baby Iver will likely need formula – and this can be tremendously expensive, particularly if baby Iver has any sensitivities and is in need of a hypo-allergenic breastmilk. The costs of formula feeding can exceed $500 per month. An excellent resource for those who formula feed is the fearless formula feeder at www.fearlessformulafeeder.com .

4. Being a parent is a very hard job, and being one to a small child is a special challenge that frequently involves sleep deprivation. It’s hard enough when there are two parents able to take on the challenge – as one can often provide some respite for the other. As a result of Mrs. Benson’s death, that respite might be unavailable or might come at a cost – on average babysitters in Victoria charge between $10-$15 per hour.

5. Being a widow is no easy task either. Mr. Benson’s story reminds me of Matt Longelin’s in some ways (www.mattlogelin.com) – he too was thrust into new parenthood and widowerhood at the same time when his wife passed within 48 hours of the birth of their daughter, Madeline. Accessing psychological counselling can run about $160 per hour.

This is why I hope that Mr. Benson can far exceed his fundraising goals and succeed in being the dad he wants to be and giving little Iver the best life he can. I hope little Iver brings him joy. I hope Iver is able to meet his full potential and always knows how much he is loved by his father and his community. I hope the financial toll of losing Mrs. Benson is mitigated to the degree possible – because the loss of a mother is already tragic enough without it also imposing financial ruin on those left behind as they try to grapple with the void that is left.

I should add that I do not personally know the Bensons – but I wish them the best possible outcome under these horrible circumstances.

If you would like to consider donating to Dylan Benson and his son, Iver – they’ve established a donation page at http://www.youcaring.com/help-a-neighbor/baby-iver-fund/133560 entitled "Baby Iver Fund"

Deconstructing the Cost of Planned Cesarean Delivery

Some people claim that women should not be free to plan a cesarean delivery because cesarean deliveries cost more than vaginal deliveries, and in a publicly run health system (like in Canada), that is unacceptable as it places an unneccessary strain on the system. As a result, the violation of patient autonomy and charter rights is "justified".

This claim needs to be deconstructed because such a violation should only happen when it can be demonstrably justified in a free and democratic society.

I believe this claim can be clearly deconstructed using data from the the Canadian Institute for Health Information's Patient Cost Estimator
I note that all data is for the province of British Columbia.

For convenience, I will assume that all repeat c-sections are planned c-sections, even though many of them will include failed vaginal birth after cesarean attempts (which would be at a higher cost as they would be emergent procedures). The average cost of these in 2008/09 was $3,410. Also for convenience, I will assume that all other births were 'planned vaginal' births regardless of whether or not they resulted in an 'actual vaginal delivery'. I note that some primary c-sections would have been lower cost planned c-sections for bonefide medical reasons, however, the vast majority of them are likely emergent/urgent c-sections done as a result of complications that emerged during labour. Weighing these births by volume, the weighted average of planned vaginal delivery in BC in 2008/09 was: $2,938.45. I note that this is likely an underestimate of the cost of planned vaginal delivery.

So, according to this back-of-the-envelope calcuation, how much does the health system 'save' by denying a women the right to choose a cesarean delivery based on these rough estimations:

That's right ladies and gentlemen - violating a patient's autonomy in BC in 2008/09 saved the health system an estimated $471.55. Assuming that 2 percent of all 'planned vaginal deliveries' would have choosen a cesarean (approximately 721 women in 2008/09), the health system saved $340,091.44. That's less than 0.3% of the money spent on deliveries in the health system in 2008/09 and less than 0.0025% of the total $15 Billion health budget in 2008/09. In 2008/09, to allow all women in British Columbia who would have choosen cesarean delivery to do so would have cost less than the amount that was paid to Vancouver Island Health Authority's CEO in salary and benefits ($417,425) in 2007/08.

I note at my therapist's rate of $160 bucks per hour is less than 3 hours worth of therapy. I'm reasonably convinced that my birth experience will need more than 3 hours of therapy to deal with - so in my particular case, denying my right to choose how my child was born will likely cost the system MORE than if the pre-labour cesarean had been granted.

I also must note that this cost difference does not include the costs that are associated with correcting the impact of vaginal delivery on the pelvic floor, the cost of caring for permanently disabled children who were injured during their mothers' planned vaginal deliveries, or the cost of birth related litigation.

So to those who say that planned elective cesarean is not a valid birth choice on the basis of cost - I would say that they need to take a long, hard look at some real numbers. I would further hope that preservation of one's charter rights should be worth more than $471.55 - which is likely a gross overestimate of the actual cost difference between thes modes of delivery.