Pre-term Cesarean birth
Friday, December 05, 2008
BY MICHAEL McGUIRE
When the March of Dimes made last month Prema turity Awareness Month, it cited premature birth as 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.
We applaud the March of Dimes for its efforts to educate people about the dangers of premature birth and to raise funds for much- needed research. Premature birth leads to a large number of 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 ba bies continue throughout their childhood and beyond.
Obviously, reducing the number of premature babies increases the number of healthy babies. Not so obvious or widely known, however, is the corresponding decrease in medical costs associated with hav ing fewer premature births. Specifically, neonatal intensive care units (NICU) and other care for newborns with health problems can be extremely expensive. So addressing this pressing health need is impor tant, not only to improve the short- and long-term health of children but for improving the affordability of health care in the country.
Everyone will therefore likely be as interested as I was to learn the results of research on NICU admis sions conducted by UnitedHealth care, the health insurance company for which I work.
It turns out that in an audit of all UnitedHealthcare-insured ba bies admitted to the NICU in one market, 48 percent of all newborns admitted to NICU were delivered by elective admission for delivery including scheduled C-sections (cesareans), many taking place before 39 weeks of pregnancy, or full term.
Medical research shows that the No. 1 contributor to the growth in the use of C-sections has been among women and their physicians opting for elective procedures, many before the 39 weeks' gesta tion period. Why do people opt for elective Cesareans? Sometimes they do it so the mother is not in the hospital on a major holiday, or to accommodate a physician's va cation or for other reasons of convenience.
Whatever the reason that women have elective C-sections be fore full term, 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 NICU than babies born at 39 to 42 weeks. No wonder that the American College of Obstetricians and Gynecologists (ACOG) discourages elective C-Sections before 39 weeks.
When we shared this 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 in NICU admis sions in three months, a decline that has held stable for more than a year. That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous.
We are now launching similar communications programs with the obstetrician/gynecologist doctors and 4,900 hospitals in our national network of health care providers. In addition, we are posting new information on our website 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.
We are calling for hospitals and obstetricians to end scheduling pre-term elective C-sections unless they are positive that the proce dure 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 C-sections are not considered elective.
There is evidence that reducing the overall number of Cesarean deliveries would 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 (AHRQ). While some women do need C-sections because of fetal distress and other medical issues, AHRQ says that more than half of all Cesareans are medically unnecessary.
That's why we believe that all hospitals should follow ACOG guidelines in their C-section delivery protocols and establish review processes for all Cesareans and elective admissions for delivery. Our research suggests that hospitals that follow guidelines have much lower NICU admission rates than other hospitals.
There is a broader principle at work here, and it's 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 evi dence 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, including babies, who use fewer health-care resources.
Michael McGuire is CEO of UnitedHealthcare of New Jersey, a health-care insurance carrier. He can be reached at michaelmcgui re@uhc.com.