The medical community could lower costs and improve outcomes for babies and moms by making a single change—stopping the practice of electively delivering babies for the convenience of doctors or mothers before baby has reached full term and labor comes on naturally.

Inducing early labor can be a matter of medical necessity, but increasingly, it's a matter of choice for doctors and patients. Along with this practice has come more expense and poorer outcomes.

Babies grow and change every week, and every week counts. Watching our first child grow at the normal astonishing rate in his first month of life, his proud dad quipped, “Wow! It looks like someone took a tire pump and blew him up!” Babies grow even faster before they are born.

Important development of a baby’s brain, lungs and liver takes place during the last few weeks of pregnancy. Babies that are born just a week or two early are more likely to end up sick and in a $3,000-a-day Neonatal Intensive Care Unit (NICU). These babies could have developmental issues for the first five years of their life. Mom is more likely to need an emergency C-section, a major surgery.

An analysis of 18,000 deliveries in 2007 found that 18 percent of babies born by choice in the 37th week required a stay in the NICU. That figure is eight percent in the 38th week, and five percent in or after the 39th week. Elective delivery adds 17 percent to normal delivery costs and about $1 billion in medical expenses annually. Illinois has roughly 10 percent of the U.S. population. One tenth of a billion dollars is a lot of money that could be used for far better purposes.

Every week makes a difference. Normal labor is a natural process that is triggered by the baby signaling that he or she is ready to be born. Until then, Mom is the best incubator.

This issue swept into the national spotlight in February of this year when the Leapfrog Group, an employer initiative to improve hospital quality, reported individual hospital rates of early elective deliveries without a medical reason for the first time. The March of Dimes and the Childbirth Connection, along with Leapfrog, are spearheading national efforts to encourage women to carry their pregnancies the full 40 weeks whenever possible. Hospitals are being called on to put policies in place to keep babies and moms safe.

Hospitals in Peoria are working on the problem and have made changes to their policies. Decatur Memorial Hospital is one of six Illinois hospitals that are implementing a comprehensive program developed by the March of Dimes to ensure inductions and C-sections are done at the right time and for the right reasons. As one March of Dimes leader said, "Just because we have the tools to induce labor doesn't mean we should be using them."

The shift to elective deliveries has been a gradual change in OB practice over the past 20 years. The American College of Obstetricians and Gynecologists recommends against delivering a baby before 39 weeks without a strong medical indication. So how did deviance from evidence-based standards become the norm? How did it happen that care intended to help is causing harm?

Quality experts will tell you, “Every system is perfectly designed to get the results that it gets.” Doctors and hospitals get paid more for C-sections than vaginal deliveries. Pregnancy is often paid as a case rate, so doctors who don’t make it to a delivery don’t get paid for months of prenatal care. Scheduled deliveries make an unpredictable event predictable so that deliveries take place at a convenient time. There is also a malpractice factor. Of the nine most common reasons for OB malpractice suits, six allege failure to perform a C-section or failure to perform a C-section sooner. Performing a C-section diminishes the chance of being sued successfully.

Healthy Babies, Healthy Moms is a statewide initiative headed by Quality Quest that is leading efforts to eliminate the unhealthy practice of elective delivery before 39 weeks in Illinois. We have great engagement from the medical community. We are going to need the help of the business community too. Truly informed parents are unlikely to choose a procedure that can cause harm to their baby. The business community can help by supporting the recommendations of the Healthy Babies, Healthy Moms team and by insisting their carrier collaborate.

The fee-for-service model encourages doing more, even when more medicine doesn’t translate to better health. Bundling payments, paying a fixed amount for all deliveries, separating payment for prenatal care and delivery, and not paying for the preventable complications that result from early elective deliveries should all be considered.

Early elective deliveries involve more care at a very great cost—a baby’s health. iBi

For more information on Healthy Babies, Healthy Moms, visit qualityquest.org.