Cesarean Sections Before 39 Weeks Increase Risks for Newborns

Although a Cesarean section can be life-saving, the procedure is increasingly being performed on low-risk women without medical indication. The rate of Cesarean delivery in the United States rose from 20.7% in 1996 to 31.1% in 2006.¹ This increase was due to:²

• Repeat procedures for subsequent births.
• Elective cesarean deliveries for patient and physician convenience.

Women who schedule an early Cesarean delivery should know that every week of pregnancy matters. New research demonstrates that Cesareans occurring at 38 weeks, one week earlier than is recommended, were 50 percent more likely to result in medical complications, including:.²

• Respiratory distress syndrome in the newborn.
• Maternal hospitalization for five or more days.
• Increased risk of maternal infection.

Why Employers Should Care:

• In 2004, prenatal care and maternity-related hospital payments combined averaged $10,958 for a cesarean delivery. An uncomplicated vaginal delivery was only $7,737.³
• The higher cost of a cesarean delivery includes $2,090 in additional hospital expenditures and $723 in additional payments for professional fees resulting from the longer length of hospital stay.³
• The average length of hospital stay for a Cesarean section is 3.6 days versus 2.2 following a vaginal delivery.⁴
• The average cost of treating one infant with respiratory distress syndrome is $56,800.⁵

What Employers Can Do:⁶

• Employers may consider reducing cost-sharing for members who opt to birth in network facilities with lower than average Cesarean section rates, that allow vaginal birth after cesarean (VBAC), and follow guidelines for electronic fetal monitoring and labor induction.
• Consider lower cost-sharing or nonmonetary rewards for women who participate in prenatal education programs.
• Prenatal education should thoroughly cover:
  
  • The importance of at least 39 weeks gestation.
  • Medical indicators and risk factors for Cesarean section.
  • Information regarding recovery differences between Cesarean and vaginal births.
  • The risks the procedure poses for subsequent pregnancies

Reference:
¹ Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. Natl Vital Stat Rep. 2007;56:1-18.

² Tita ATN, Landon MB, Spong CY, et al. Timing of elective repeat Cesarean delivery at term and neonatal outcomes. N Engl J Med. January 8, 2009;360(2):111-120.

³ Thomson Healthcare. The healthcare costs of having a baby. Santa Barbara, CA: Thomson Healthcare; June 2007.

⁴ National Committee for Quality Assurance. The state of health care quality: Industry trends and analysis, 2007. Washington, DC: National Committee for Quality Assurance; 2007.

⁵ Russell RB, Green NS, Steiner CA, et al. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120(1):e1-9.

⁶ Goff VV. The Institute on Health Care Costs and Solutions. Cesarean delivery. Washington, DC: National Business Group on Health; 2007.