Why do families opt for elective Caesarean sections before full term? Sometimes they do it so the mother is not in the hospital on a major holiday, or to accommodate a physician's vacation or for other reasons of convenience.
Whatever the reason that women give for having elective C-sections before the full term of 39 weeks of pregnancy, it's bad for the baby. Recent research reveals that newborns delivered prior to 39 weeks are twice as likely to end up in the neonatal intensive care unit (NICU) than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists discourages elective C-sections before 39 weeks.
According to the March of Dimes, premature birth is the No. 1 killer of American newborns. The March of Dimes says that the rate of premature births is now 12.1 percent of all births, up from 9.4 percent in the early 1980s.
Premature birth leads to health problems for newborns, including respiratory distress syndrome, chronic lung disease, serious vision problems, heart murmurs and jaundice, to name a few. The health challenges of some premature babies continue throughout their childhood and beyond.
NICU and other care for newborns with health problems is also extremely expensive. So addressing this pressing health need is important, not only to improve the short- and long-term health of children but to help make health care more affordable.
Research tells us that the No. 1 factor in the growth in the use of C-sections has been women and their physicians opting for elective procedures, many before the 39 weeks' gestation period. A recent audit of all UnitedHealthcare-insured babies admitted to the NICU in one market found that 48 percent of all newborns admitted had been delivered by an elective procedure, including many scheduled C-sections, many taking place before full term.
When we shared our startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective admissions for delivery prior to 39 weeks, including C-sections.
The result: There was a 46 percent decline of NICU admissions in three months, a decline that has held stable for more than a year. That's almost half the numbers of newborns with potential health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health care system is enormous.
UnitedHealthcare is now launching similar communications programs with the OB/GYN doctors and 4,900 hospitals in our national network of health care providers. In addition, we are posting new information on our Web site and updating our Healthy Pregnancy Owner's Manual that we give to expectant parents with key messages about the dangers of early elective C-sections.
I would like to call on all hospitals and obstetricians to stop scheduling preterm elective C-sections unless they are positive the procedure won't take place until after the baby has reached 39 weeks. Note the word "elective," because sometimes there are pressing medical reasons for a scheduled premature C-section -- those are not considered elective.
Reducing the overall number of Caesarean deliveries should significantly reduce health risks for mothers and their newborns. More than 1.2 million C-sections are performed annually in the United States at a cost of more than $14.6 billion per year, according to the federal Agency for Healthcare Research and Quality. While some women do need C-sections because of fetal distress and other medical issues, the agency says that more than half of all Caesareans are medically unnecessary.
The American College of Obstetricians and Gynecologists has guidelines that all hospitals should follow in their C-section delivery protocols. Our research suggests that hospitals that follow these guidelines have much lower NICU admission rates than other hospitals.
The broader principle at work here is called evidence-based medicine. As it turns out, for many conditions there is a great variance in how different physicians treat their patients.
If health care insurance companies and medical caregivers work together, we can identify from real-world evidence the best practices for a wide variety of medical conditions. As we can see in the case of early elective C-sections, using evidence-based guidelines in medical care will lead to healthier outcomes for patients.
And it's a funny thing about health care: virtually everything that makes people healthier, be it preventive care or evidence-based guidelines, reduces the overall cost of providing health care because it leads to healthier people.
Sanford Cohen, M.D., is the chief medical officer of the Northeast region of UnitedHealthcare.