Re epidurals and managed care:  I know that in this town, my HMO contracts
with the hospital, so the HMO repays the hospital for any charges, including
epidurals, so the hospital is still gung-ho about them.  I had my last child
in 1991, before the days of "managed care/capitated care" and could have had
anything I wanted -- an epidural, a C-section, whatever.  In my HMO, which
is *wonderful* I want to be sure to say, a pregnancy costs a grand total of
$60 for the co-pay.  Yes, that's right, $60.  That includes the initial
confirmatory test, all blood work, all sonograms, all office visits, and all
hospital costs at the delivery.  All you have to pay for is the phone.  I
think they even pay for the TV in the room.  In my case, there was also an
amniocentesis, and two visits with a *wonderful* genetic counselor, for
which I didn't have to pay a cent.  It may be that as things get tight,
OB/GYNS working in a capitated care system will start trying to discourage
their patients from using epidurals, but I think for now they go on covering
the cost of all the "usual" (if not *standard*!) things for their patients.

I remember several years ago reading studies of the Caesarian-section rate
at public/county hospitals versus private-pay hospitals, and the
Caesarian-section rate was much higher at the private-pay hospitals, but the
conclusion was that through the cost-cutting measures of NOT doing
Caesarian-sections at the county hospital, the women there were actually
getting the better care.

Re constipation:  My only solution is lots of apple juice and/or prune
juice.  I know that Peter (our ten year old with Down Syndrome) used to
consume huge quantities of apple juice, and that contributed to chronically
soft stools, which made it extra difficult for him to learn how to control
his bowels.  He wasn't toilet-trained until he was 9 years old, and I'm
convinced that part of it (probably the largest part of it) was because his
stools were always so soft they didn't trigger normal feelings of needing to
poop ahead of time.  Also, I know an older woman who has chronic
constipation who eats a bowl of cereal every morning that includes bran
flakes, prunes, apricots, and then is sprinkled with Metamucil.  I would be
a little concerned that something very serious might be the issue here,
though -- has a pediatric gastroenterologist been consulted?  Maybe you
could contact Maryelle Von Lanthen, if she is still on0line?

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Katherine A. Dettwyler, Ph.D.                         email: [log in to unmask]
Anthropology Department                               phone: (409) 845-5256
Texas A&M University                                    fax: (409) 845-4070
College Station, TX  77843-4352