Health Plans Work to Reduce the Health Risks and Costs From Elective C-Sections Before Full Term

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A combination of quality-of-care and cost issues has prompted some health plans to take steps to reduce the number of scheduled, medically unnecessary premature Caesarean section deliveries, mainly through a focus on education of both women and physicians.

... a growing percentage of women is having C-sections, many of which take place before the 39th week of gestation ... between 1990 and 2005 there was a 20% increase in babies born before the 37th week of gestation and a 29% increase in births occurring at 37 to 39 weeks of gestation. Many studies show heightened risks to both babies and mothers when the babies are delivered before 39 weeks.

Although there are certainly medically necessary reasons for some of these C-sections, newborns delivered prematurely are at risk for more medical complications than those born at full term. Many of these infants are admitted to the neonatal intensive care unit, which can be much more costly for health plans than a C-section or vaginal birth without NICU admission.

There were more than 1.3 million C-sections in 2006 in the U.S., up from less than 800,000 in 1996 ... plans have asked what they can do about this growing rate ... “This is not the important question, but it’s the one everyone asks,” she maintains. Rather, she says, the focus should be on what these high C-section rates represent, which is a quality issue mainly with babies and the impact of neonatal costs. “The real quality issue has more to do with the infant than the mom,” ...

“This is both a quality-of-care and a cost issue,” ... “A baby should not be born electively before 39 weeks unless there is a clinical indication” to do so ... while NICU costs “are not the No. 1 issue ... they are in the top couple of issues,” she explains. Average costs for a vaginal delivery are between $5,000 and $6,000, while costs for a C-section delivery are in the $8,000 to $9,000 range. But for births resulting in a NICU stay, those costs jump to the $20,000 to $30,000 range ...

... “While maternal and fetal complications during pregnancy may result in the need for a C-section, we’re concerned that some early C-section deliveries may be occurring for non-medically indicated reasons,”

... “the rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks.”

... late preterm babies — ... between 34 and 36 weeks gestation — are six times more likely than full-term babies to die within their first week of life and three times more likely to die within their first year. Groat says that babies born within the 37- and 38-week time frame “have twice the likelihood of going to the NICU” than babies born at 39 weeks.

... If women have already had a C-section, they can safely have a ... VBAC later...

... Many plans are taking steps to help reduce the amount of scheduled premature C-sections.

... 48% of babies admitted to the NICU were born to mothers who had scheduled deliveries, many of which were before 39 weeks gestation. After the plan shared its data with the hospitals and physicians in those areas, there was a 46% decrease in NICU admissions within the first three months ... “We’re taking some of the best practices and sharing them with hospitals,” she explains. ... “the last few weeks of pregnancy are important to the baby,” ...

... The Regence Group has a maternity management program, Special Beginnings, designed to promote a healthy pregnancy and delivery. “... we work to educate expectant mothers about the potential incremental risks to mother and infant” when the baby is delivered by C-section electively before the 39th week of gestation ... “Through this program, we educate expectant mothers on the benefits of full-term, vaginal delivery to help encourage a healthy pregnancy and delivery. We also educate them about when it may be medically indicated to not have a vaginal birth.” ... It also offers members a 24-hour health information line that includes mortality and morbidity information affecting both mothers and babies with elective delivery before 39 weeks ... “This helps educate the mother if her doctor suggests early delivery,” ...

Melissa Maimann, Essential Birth Consulting 0400 418 448