Op-Ed Piece on Elective Cesareans

This opinion piece was written by the CEO of UnitedHealthcare of New Jersey, a health insurance carrier, on elective C-sections and NICU admissions, etc., which I’ve blogged about previously, and I’ve seen it blogged about extensively on other blogs.

I’ll pull a few quotes from here, but I urge you to read the whole thing [any bold or italics will be mine]:

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.

Note that “elective admission” includes scheduled C-sections as well as inductions of labor — inductions which may ultimately have failed and then required a C-section to complete the birth of the baby. While I find it extremely interesting, not to mention unsettling, that almost half of the NICU admits were due to “elective admission” for birth (I would assume from the language that these are all not medically necessary; although I could be wrong in that), I will point out that “full term” is not usually defined as 39 weeks of pregnancy, but rather 37 weeks — although not too many years ago it was 38 weeks. Still, in another way of looking at it, I only consider “full term” to be when labor begins spontaneously — there is so much we don’t know about labor and birth and a baby’s maturity, that to cause the baby’s birth prior to natural onset of labor is to risk prematurity — regardless of the week of gestation.

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, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous.

Reducing elective admissions prior to 39 weeks significantly reduced the number of babies that needed to have intensive care in a hospital setting. Not only does this translate into significant cost savings (which is of high importance to an insurance provider, naturally), but think of how many lives have been altered, perhaps tragically, by these unnecessary inductions and C-sections which led to many days or even weeks in the NICU, for no medical reason!

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.

My thanks to Empowering Birth for originally blogging about this article, thus bringing it to my attention.


8 Responses

  1. Thanks for a great look at this article! It is all I can do to get stuff out on my blog now-a-days. Thanks for the much needed closer look. Shocking Op-ed isn’t it.

  2. Elective c-sections were on my mind today as well. Amazing that anyone would choose to have a c-section if they don’t medically need to.

  3. […] at Women to Women Childbirth has an article about Elective Cesareans.  I am not sure how Kathy does it, but she reads these articles, finds the studies and then […]

  4. I remember when this op-ed piece was published. I was reluctant to write about it because, even though it’s chock full of data on the perils of rushing the birth process, it is written by the CEO of an insurance company. Since one of the many backlash arguments against lowering the c-section rate is that the REAL reason that institutions would be onboard with lowering the rate is purely financially motivated, I shyed away from this.

    The main reason cited elsewhere for NOT working to lower the Cesarean rate is that more evidence is needed to make sure that women and babies will not be harmed in the process. “Experts” have been saying that since long before the c-section rate hit 20% and now 1 in 3 women will get surgery.

    The other reasons are that we’re all fat, old and/or requested them in the first place. VBAC bans are also acknowledged. Fear of litigation is a big one, but no one seems to mention that unnecessary inductions-cum-cesareans and coercive prophylactic sections with no evidence-based medical indication are pervasive in the U.S. and abroad. When performed too early, more newborns end up in the NICU and it all comes full circle.

    • Jill,

      What you said is true, but if this article is the truth (which I believe it is), then I’m less concerned with who wrote it, and just glad people are speaking up. *Something* has to give; and we are a free-market society (sort of), which means that money talks. I am concerned about what will happen when health insurance companies begin refusing to insure women who have had previous C-sections (as some have already done — I’ve blogged about it in the past, maybe almost a year ago now), unless they can prove that they have been sterilized. “C-section as a pre-existing condition” which may prevent some women being insured because of the high repeat C-section rate (and costs associated with it) is, I’m afraid, going to become the norm before too much longer. I’m afraid that if steps aren’t taken now to lower the C-section rate (and/or increase the VBAC rate), then women are really going to be put into a bind: doctors won’t allow VBACs because of their malpractice insurance concerns, and health insurance won’t allow elective C-sections because of the high cost associated with them — then what? Then women will have to pay for their unwanted “elective” C-sections out-of-pocket? Pay even higher premiums for health insurance because they’ve got a scarred uterus? Or just higher premiums for maternity health insurance?

      Hospitals can take some simple steps to reduce the rate of C-sections — if they *will*. We all know the C-section rate used to be very much lower (and that was when it was true that “once a Cesarean, always a Cesarean”); they just have to get women off the assembly line so they can keep doing necessary C-sections and stop doing unnecessary ones. Why is it that midwives have low C-section rates? It’s not because women and babies are being harmed by avoiding C-sections, but because of the care midwives give.

      I know I’m preaching to the choir, here! 🙂 But it seems like everyone is waiting for everyone else to make the first move. I don’t want health insurers to be the first to move — we see what a mess it’s made of VBACs when malpractice insurers moved! — but if everybody else sits around with a thumb up their collective posterior, then I don’t see another alternative.

  5. Good point. Who cares who spoke up? Someone did.

    Saving everyone money will drive many changes during the recession, right? So if one of the benefits of improving maternity care happens to be saving money, so be it. Everyone will be happy… except for those trying to protect the status quo. And when you have a surgeon waiting around for birth to take its course normally, time IS money. Tick tock.

  6. The ceo who wrote this is from the insurance company that I have. This is the same insurance that considered my homebirth (of my second child–a healthy 40 weeker) to be out of network. Except that they don’t have any homebirth midwives in network. Therefore when charged $6000 by my midwife for the whole birth and prenatal care they got away with only paying about $2000 (after some complicated calculations on their part). Anyway, I plan to write him a letter about ways they can really save money. Also, my son was born in a hospital and kept in the NICU for 5 days when they finally discovered that his blood test has been contaminated and he did not have Group B Strep. The Insurance company covered the whole (distressing and traumatic for me) vaginal birth and the whole NICU stay while we only paid a $30 copay. Ironic. Sorry just venting. It is good if they are recognizing that things have to change regarding c-section rates and the cost both monetarily and healthwise to the mother and baby. I just hope that this can lead to a better attitude regarding homebirths so that the pregnant mom doesn’t have to spend all her time jumping through insurance hoops and worrying that they won’t cover the homebirth.

    • Renee,

      Please do write that letter! It bothers me that insurance companies will be so money-conscious that they will refuse to cover elective (forced) repeat C-sections, yet won’t cover the home birth that will prevent many of those C-sections in the first place. When I asked my first midwife (a CNM) about why, she said that doctors sit on insurance boards, deciding what procedures will be covered, and they (being in the good ol’ boys network!) don’t like midwives, midwifery and/or homebirth, so they will refuse to pay for births at home, even though they could save a lot of money by so doing. Weird, huh?

      It might also help to ask them to double-check their charges and allowable costs and what-not that you mentioned above. It is not unusual for insurance companies (as a cost-cutting measure, of course) to automatically deny claims they don’t want to pay, or to screw up the paperwork on claims (possibly just human error), or to look for loopholes to avoid paying, or to conveniently forget that if they don’t have an in-network provider they have to cover the out-of-network provider as if she were in-network (of course, not all insurance companies have this policy, but it might be worthwhile to see if yours does). I’m sure most people give up after the first or second try, but sometimes it is worth the effort to get it covered.

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