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this often unnecessary medical procedure. The average caesarean costs nearly twice what a vaginal birth does—$24,700 compared to $14,500. A California Maternal Quality Care Collaborative white paper asserts that while in some cases, like breech birth, caesareans are clinically necessary, in many cases they have “greater risks and complications than vaginal birth.” The report, published in December 2011, notes that:
Higher caesarean delivery rates have brought higher economic costs and greater health complications for mother and baby, with little demonstrable benefit for the large majority of cases. With the marked decline in vaginal births after caesarean, caesarean deliveries have become self-perpetuating; and every subsequent caesarean brings even higher risks .
    The costs are significant. The white paper’s coauthor, the Pacific Business Group on Health, estimates that additional caesareans cost public and private payers in California at least $240 million in 2011 alone. An effort to reduce caesareans could save California between $80 million and $441.5 million a year, depending on the number of caesareans prevented. And that is just one state.
    Time is money. Hospitals want women to give birth and get out. So lengthy labor, with all the breathing, walking, moaning, snacking, and napping, is not allowed. After a few hours the pressure for Pitocin begins, but the drug makes the contractions much harder, longer, and more painful, and women are not prepared for the pain. An epidural or local anesthetic may arrest the pain, but it also slows the labor, which often leads to more Pitocin and another epidural. And now the baby is being squeezed and pushed by the harder contractions and is having a harder time in the birth canal. The baby goes into distress, and then a caesarean is necessary. Self-fulfilling prophecy.
    To be honest, I never really thought all that much about health care before I was pregnant. We didn’t have any while we were growing up. Our parents and our community depended on doctor friends for care and prescriptions. Lee Randoll was an old-school doctor who made house calls, prescribed aspirin for most ailments, and convinced our parents not to get our tonsils taken out. He was tall and lean and carried an old-fashioned doctor bag. When Lee retired and then later died, we went to the poor people’s clinic a few miles away. I remember being shocked when the doctor asked me if I was sexually active. I was only eleven or twelve years old at the time.
    We got our teeth cleaned at a community dental clinic and the dentist supported our family’s peace work enough to set me and my sister up with braces at a drastically reduced rate. It’s kind of funny that we got middle-class teeth because our parents were poor revolutionaries.
    As kids, we ended up in the emergency room with broken bones or bad hives more than once. My brother lost the tip of his finger when it got slammed in a door during a fight, and my mom carried the little nub of flesh with her to the hospital. When the bills came due, I think our folks just wrote a letter explaining their circumstances and then paid what they could.
    In college, I used the school health services—mostly for reoccurring strep throat. Then I moved home and relied again on family friends. After peeing in the woods following an Indigo Girls concert, I got poison ivy so bad that my eyes swelled shut and blisters formed inside my nose. A doctor friend hooked me up with a prescription for steroids, and the itching and oozing cleared up like magic.
    Later, when I moved to New York City and got my first real job, having health care seemed like a symbol of adulthood. However, it was also a major pain. I spent hours trying to figure out which doctors took my insurance, whether they were accepting new patients, and if they were located anywhere near my home or office. I ended up going to a community health center right near my office that took my insurance. I mostly saw