Everyone who looks at the high cost of health care worries about the expense at the end of life.
But what about at the beginning?
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Turns out there’s one deceptively simple change in obstetric care that can save millions of dollars and lead to healthier babies and healthier moms: stopping women and their obstetricians from inducing births before 39 weeks without a pressing medical reason.
That could be a tough sell though because early induction has become part of the culture.
About one in 10 births in the United States is intentionally early, and some estimates are higher. It’s a matter of choice and convenience, and sometimes efficiency, for both women and their doctors. A baby born at 38 weeks — a common time for early induction — isn’t premature. It sounds safe.
But mounting evidence shows that planned early births put babies at risk: more infants staying in neonatal intensive care units, more complications, more permanent damage and a higher death rate. Respiratory and digestive problems occur, and scientists are learning how early delivery can disrupt brain development.
There’s “an explosion of brain development in the last few weeks of gestation,” Billie Short, division chief of the Neonatal Intensive Care Unit at Children’s National Medical Center in Washington, said in a presentation about the costs and consequences of elective early births.
So private insurers, health quality groups, the March of Dimes, some large hospital organizations and now Medicaid — which pays for more than 40 percent of births in the U.S. — have teamed up to spread the word to women who are expecting. Their message: If nature intended for babies to be born at 38 weeks, pregnancy wouldn’t last 40 weeks.
“This is something that has got to change,” said Cindy Mann, Medicaid director at the Centers for Medicare & Medicaid Services — which along with its state partners could save hundreds of millions of dollars a year if such births were less common.
A baby born at 37 or 38 weeks isn’t premature, these groups tell women and doctors. But maybe they aren’t quite “full term,” either. The phrase being introduced is “early term.”
The message isn’t always getting through.
“We live in a culture of convenience and a culture of planning,” said Sue Gullo, managing director of the Institute of Healthcare Improvement, “Our whole culture is about making things neat and tidy,” she added.
A woman might want to avoid a particular birth date or choose to deliver when she knows it’s convenient for grandma to watch the older kids. She might try to maximize her maternity leave or improve the odds of having a specific obstetrician in a group practice when she delivers. Or she may just get tired of being hugely pregnant.