DALLAS – UnitedHealth-care, a UnitedHealth Group, has expanded its efforts to help reduce neonatal intensive care unit admissions for babies delivered by scheduled cesarean-sections, an initiative supported by the March of Dimes, the leading nonprofit organization for pregnancy and baby health.
More than 1 million cesarean-sections are performed annually and while some women may need medical intervention as a result of fetal distress and other medical issues, some of the cesarean-sections are elective and medically unnecessary.
Findings of a nationwide study published in the January 2009 edition of the New England Journal of Medicine revealed that 35.8 percent of elective cesarean deliveries were performed before 39 weeks of gestation. With this in mind, UnitedHealthcare is expanding its data-sharing and educational efforts to include hospital facilities in the central and southeastern United States.
UnitedHealthcare performed a 2005 review of sample data in selected markets in the southwestern U.S. that showed 48 percent of newborns admitted to the NICU were from scheduled admissions for delivery – many before 39 weeks gestation, a practice that is discouraged by the American College of Obstetricians and Gynecologists.
After UnitedHealthcare shared its findings, physicians and hospitals in the pilot altered practice patterns and realized a 46-percent decrease in NICU admissions in the first three months – a decline that has held stable.
“Based on ongoing review of our own data as well as a recently released national research study, we know reducing the overall number of elective caesarean sections will translate to fewer NICU admissions and fewer health complications for newborns,” said Tina Groat, M.D., national medical director of Women’s Health for UnitedHealthcare.
“The difference of health outcomes between 37 weeks gestation and 39 can be alarming and we are eager to get this important message out.”
Medical research shows the greatest growth in the rate of cesarean-sections is among women and their attending physicians who are opting for elective procedures, many before 39 weeks gestation, usually to accommodate the patient’s or physician’s schedule.
The New England Journal of Medicine study involving more than 24,000 cesarean-sections, revealed that babies born at 37 weeks gestation were twice as likely to have health problems, usually respiratory in nature, than babies born at 39 weeks or later. Admissions to the NICU within this study were 5.9 percent at 39 weeks gestation and rose to 8.1 percent at 38 weeks and 12.8 percent at 37 weeks.
“Our own findings are consistent with this analysis,” Groat said. “After working with select physicians and hospitals within our own network, we saw a marked reduction in NICU admissions. These are results we want to share not just with our own physicians but with others nationwide who can benefit.”
“UnitedHealthcare’s work with physicians and hospitals is in line with our mission to improve the health of newborns by reducing unnecessary cesarean-sections that may put them at risk. The simple message is: ‘Please don’t schedule a cesarean-sections prior to 39 weeks unless it is medically necessary,’” said Alan R. Fleischman, M.D., senior vice president and medical director for the March of Dimes.
“The rate of cesarean-sections continues to grow – accounting for 20 percent of live births in 1996 and increasing to 31 percent in 2006. This is due in part to a decline in the number of women allowed to attempt vaginal births after they’ve had cesarean-sections, coupled with a desire to accommodate patient and physician convenience,” Fleischman said. “It’s a trend that has to be reversed. It’s important that we talk about the dangers associated with these early cesarean-sections that are not medically necessary.”
Additionally, UnitedHealthcare has enhanced its Healthy Preg-nancy Program Web site, www.healthy-pregnancy.com, and recently introduced a new “Mom(me)” kit and breastfeeding DVD for expectant and new mothers. The Healthy Pregnancy Web site and kit include educational information for expectant women about elective deliveries, including risks to mothers and their babies for elective cesarean-sections prior to 39 weeks’ gestation. These useful tools also provide expectant parents with access to important information on scheduling delivery and key factors to consider about elective deliveries such as:
•a baby’s brain at 35 weeks weighs only two-thirds of what it will weigh at 39 weeks;
•babies’ lungs may not be fully developed until 39 weeks gestation;
•babies born before 39 weeks gestation can be at increased risk for respiratory problems and other conditions that might require special care;
•women who have labor induced are more likely to need a cesarean-sections or experience other labor complications.
Currently, more than 1.2 million cesarean-sections are performed annually in the United States – often at an increased risk to newborns – at a cost of more than $14.6 billion per year, according to the federal Agency for Healthcare Research and Quality.
The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.com or nacersano.org.
For more information about UnitedHealthcare, visit www.unitedhealthcare.com.