Stopping Unnecessary Baby Deliveries

A unique partnership lowers the rate of elective births while improving infant health
By Bruce Japsen

Unnecessary elective baby deliveries, which can arise when patients demand convenience and busy doctors agree to their demands, have plummeted in Illinois with the help of a unique collaborative effort. The Midwest Business Group on Health (MBGH), which represents large employers in the Chicago area, said the rate of early elective deliveries—babies delivered too early for non-medical reasons—were reduced to 2% of all births last year from 24% in 2010.

To lower the rate of unnecessary deliveries, MBGH worked with the state’s physicians and hospitals and other stakeholders such as the March of Dimes and Blue Cross and Blue Shield of Illinois on a major educational effort aimed at stopping unnecessary elective deliveries. Stakeholders involved say their efforts can be replicated and used to help improve infant health nationwide.

“We reached out to area hospital systems in 2010 to encourage implementation of hard-stop policies that require approval of a designated hospital maternity leader prior to allowing induction of a pregnancy prior to 39 weeks,” Margaret Rehayem, senior director of strategic initiatives at MBGH, said. “We encouraged Illinois health plans to disseminate regular communications to educate members and physicians about the importance of full-term births and working with network providers to avoid unnecessary early deliveries.”

Studies show a baby’s health can be put at risk when deliveries are induced via Cesarean section before 39 weeks. Complications can include more C-sections, infections, infant breathing and feeding problems, and possible death. Though pregnancy is generally thought of as a 9-month period, studies show a baby actually needs a gestation period of 39 weeks.

Stakeholders said some hospitals brought together physicians, nurses and health information management to make sure new policies were carried out. They also consulted with the Joint Commission and Illinois Department of Public Health to determine what data was needed to come up with measurements.

“The Illinois Perinatal Quality Collaborative and Illinois Hospital Association reached out to their physicians back in 2012 to begin educating them on the impact of unnecessary elective deliveries, promoting the new American Congress of Obstetricians and Gynecologists’ guidelines that defined an unnecessary early elective delivery as being prior to 39 weeks of gestation without medical approval and encouraging physicians to promote full-term births in their practices,” MBGH’s Rehayem said.

The Results

The effort was funded with the help of a three-year grant from the National Business Coalition on Health, which represents large employers like Boeing, Abbott Laboratories and Walgreens; United Health Foundation, a nonprofit affiliate of health insurance giant UnitedHealth Group; and the Robert Wood Johnson Foundation.

More than 70% of Illinois hospitals reduced the number of unnecessary C-sections and inductions, said MBGH executives, who used data compiled from hospitals via The Leapfrog Group, which mobilizes employer purchasing power in an effort to push providers to improve quality. “Today, there are thousands fewer babies suffering in neonatal intensive care units (NICUs) in Illinois, thanks to inspiring leadership,” Leapfrog president and chief executive officer Leah Binder said.

Those involved say the educational effort to doctors, hospitals and patients is ongoing and aggressive in its effort to reach millions of health plan enrollees across Illinois.

At Chicago-based Health Care Service Corp., parent of several health plans including Blue Cross and Blue Shield of Illinois and Blue Cross and Blue Shield of Texas, the plans launched a “Special Beginnings Program” that includes educational content aimed at promoting the March of Dimes campaign, “39 Weeks—Healthy Babies Are Worth the Wait,” the insurer said in a statement to Chicago Medicine. “We have a direct link to March of Dimes video explaining the benefits of not choosing non-medically necessary inductions prior to 39 weeks,” said Toni Allen, senior manager of clinical operations at BCBSIL. “This information is available to not only members who have a Blue Access for Members account but also the public can assess this information. Our website also includes supportive written educational materials on this topic.”

Employers involved in the effort say reducing unnecessary elective deliveries likely reduced health care costs and improved the health of mothers and infants across the state. “This is the first public health problem we’ve actually been able to solve in my 40+ years in health care,” said Larry Boress, MBGH president and CEO. “We’ve shown that by coordinating efforts across all health care stakeholders, we can fill gaps in care and improve the overall health of targeted populations. It’s a template for other communities and health conditions.”