Born Too Early: Improving Maternal and Child Health by Reducing Early Elective Deliveries
Nationwide, up to ten percent of all babies are scheduled for delivery via labor-inducing medication or cesarean section before 39 weeks gestation without medical indication.1 Despite the serious neonatal and maternal health risks associated with early elective deliveries (EED), many women deliver during this time period due to provider preference, convenience, or for relief of symptoms.2 ,3 Evidence suggests that most women are unaware of the possible dangers of choosing to deliver their babies prior to 39 weeks gestation.4 Health plans and health plan foundations can play an important role in reducing EEDs by implementing payment reforms, collaborating with state and local government and community-based organizations, and educating health care providers and members about the dangers of EED.
This brief will discuss the health risks and costs associated with early elective deliveries, federal government and national initiatives to support full-term pregnancies, and health plan and health plan foundation ap-proaches to reducing EED.
Early Elective Deliveries: Paying the Price
The potential negative health consequences of early elective delivery, along with the associated costs, are placing an unnecessary burden on infants, mothers and the health care system as a whole.
Infants Face An Increased Risk Of:
- Lower brain mass – the brain at 35 weeks weighs only two-thirds of what it does at 39-40 weeks5
- Low birth weight – the average preterm baby weighs less than 5 pounds while the average full-term baby weighs between 7 and 8 pounds6
- Feeding problems7
- Respiratory distress syndrome (RDS) – one in ten premature babies develop RDS8
- Longer hospital stays – the average newborn stay is 2 days versus 14 days for preterm infants9
Mothers Face An Increased Risk Of:
- Postpartum depression10
- Cesarean delivery – elective inductions are two times more likely to result in cesarean delivery11
- Complications requiring longer hospital stays – the average vaginal delivery stay is 2 days versus 4 days for a cesarean delivery with complications12
Price to the Health Care System:
Elective induction of labor is associated with an increased risk of a cesarean delivery, and average total payments for cesarean births are close to 50 percent higher than payments for vaginal births (Figure 1). In addition, infants born prior to 39 weeks are more likely to have stays in the neonatal intensive care unit (NICU), at a considerable increased expense to both commercial insurers and Medicaid (Figure 2).
Federal & National Initiatives
Reducing early elective deliveries is key to reducing the nation’s infant mortality rate and improving birth outcomes.13 The U.S. currently ranks 32nd in infant mortality compared to other industrialized nations, and the Department of Health and Human Services’ Secretary’s Advisory Committee on Infant Mortality has called for a reduction in the infant mortality rate from 6.15 to 5.5 per 1,000 live births by 2015.14,15 In order to achieve this goal, many federal government agencies and national organizations are spearheading important initiatives to prevent preterm birth and early elective deliveries.
These efforts include developing evidence-based interventions at the state level; improving hospital quality reporting to evaluate progress in reducing EEDs; sharing data, best practices, and other resources; and creating provider and consumer educational campaigns. More information on these diverse initiatives can be found in Appendix A.