Grandma- and grandpa-to-be are flying in from across the country to help with the newborn. The closest OB/GYN is 50 to 60 miles away. The start of the hectic school year is nearing.
Whatever the reason, scheduling a C-section or inducing labor a week or two before a baby’s actual due date is a tempting option for thousands of busy, expectant mothers to make the timing of a birth more convenient. For decades, many doctors considered those early deliveries safe if the baby was at least 37 weeks along.
But hospitals and other health care providers are increasingly challenging the practice. They warn that choosing to deliver even one week early could threaten the development of a baby’s lungs, brain or other vital organs.
Now, Georgia health officials are hoping to improve care — and save money — by steering pregnant women and doctors away from medically unnecessary early deliveries by eliminating Medicaid payments for elective C-sections and induced deliveries before 39 weeks. The move, which will take effect July 1, will save the state’s ailing Medicaid health program for the poor an estimated $7 million this fiscal year and next by avoiding costly medical complications and stays in neonatal intensive care units.
“This was a policy decision that will result in better health outcomes for Georgia families,” said Christopher Schrimpf, a spokesman for the Georgia Department of Community Health, which oversees Medicaid. “But it also has a secondary benefit of being financially sound.”
The state’s Medicaid budget is facing a nearly $400 million hole despite tens of millions of dollars in proposed cuts over the next couple of years.
A mother waiting at least 37 weeks to give birth was long the industry standard. Several studies in recent years, however, have shown that babies born even a week or less prior to 39 weeks are more likely to have development problems and need specialized hospital care.
There is a short-term cost with babies having to stay in neonatal intensive care, as well as the long-term costs of caring for developmentally delayed children, said Dr. Dean Greeson, chief medical officer for Peach State Health Plan, which provides health coverage to pregnant women on Medicaid.
“The state saw this as a way to get at both of those issues,” Greeson said.
Research shows the cost of care in a neonatal intensive care unit can average $15,000 a day, though costs vary widely depending on the complexity of a baby’s condition. Babies can suffer from hearing, vision and breathing issues among other problems.
Over the last two years, Peach State has worked to educate hospitals, doctors and pregnant women about the need to wait the full 39 weeks before giving birth, unless an early delivery is medically necessary.
Making it policy and part of standard procedure is critical, said Dr. Alan Joffe, Peach State’s community medical director.
There is a lot of social pressure on doctors to deliver a baby when the woman’s body has clearly indicated it’s time, rather than hastening a birth because grandma is coming to help or a patient in rural Georgia has to travel 50 or 60 minutes to the hospital, Joffe said.
Those are important issues, Joffe said, but “what the studies and the data are showing is what’s more important is to wait the 39 weeks.”
WellStar Health System has worked for the past four years to end purely elective early deliveries.
It takes a change in culture for both doctors and patients, who have liked the convenience factor of scheduling elective births, said Dr. Perry Busbee, chief of WellStar’s OB/GYN services.
“It’s a difficult journey,” Busbee said. “When we started this … (patients) didn’t understand why they couldn’t have their baby at 38 weeks when they had their last baby at 38 weeks.”
The health system has seen its number of elective early deliveries plummet dramatically and hasn’t had one since last May.
When Pooja Mishra was thinking about having her son delivered early, she didn’t initially see it as a big deal.
She liked the day Oct. 10, 2010 — 10 days before her due date — and had talked to co-workers who had given birth early with no problems. Then Mishra, who heads oncology operations at WellStar’s Kennestone Hospital, learned about the risks it carried and didn’t think twice about waiting the full length of time.
“I’ve been working in health care for the last eight years,” she said. “But I still didn’t quite understand the impact on the development of the child’s brain.”
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