Quest Projects : Healthy Babies, Healthy Moms
The medical community could lower costs and improve outcomes for babies and moms by making a single change – stopping the practice of electively delivering babies for the convenience of doctors or mothers before baby has reached full term and labor comes on naturally.
Nationally, 14 percent of deliveries occurred too early, according to recent data released by the Leapfrog Group. The average varies widely among hospitals, with some reporting 40 percent of deliveries as early elective.
Quest has launched a state-wide maternity project to eliminate elective pre-term inductions and C-sections. The Healthy Babies, Healthy Moms Team gathers representatives from hospitals and organizations to address the issue.
The Best Incubator
An unborn baby requires at least 39 weeks in the womb to develop fully.
Important development takes place in a baby's brain, lungs and liver during the last few weeks of pregnancy. Babies that are born just a week or two early are more likely to end up sick and in a $3,000-a-day Neonatal Intensive Care Unit (NICU).
An analysis of 18,000 deliveries in 2007 found that 18 percent of babies born by choice in the 37th week required a stay in the NICU. That figure is 8 percent in the 38th week, and 5 percent in or after the 39th week.
In addition, elective delivery adds 17 percent to normal delivery costs, about $1 billion in medical expenses annually.
A Shift to Elective Deliveries
The shift to elective deliveries has been a gradual change in OB practice over the past twenty years. The American College of Obstetricians and Gynecologists recommends against delivering a baby before 39 weeks without a strong medical indication.
So how did deviance from evidence-based standards become the norm? How did it happen that care intended to help is causing harm?
- Quality experts will tell you, "Every system is perfectly designed to get the results that it gets." Doctors and hospitals get paid more for C-sections than vaginal deliveries. Pregnancy is often paid as a case rate so doctors who don't make it to a delivery don't get paid for months of prenatal care.
- Scheduled deliveries make an unpredictable event predictable so that deliveries take place at a convenient time.
- Performing a C-section diminishes the chance of being sued successfully. Of the nine most common reasons for OB malpractice suits, six allege failure to perform a C-section or failure to perform a C-section sooner.
Healthy Babies, Healthy Moms
There is no good reason for elective early deliveries. Every week makes a difference. Normal labor is a natural process that is triggered by baby signaling that he or she is ready to be born. Until then, Mom is the best incubator.
The Healthy Babies, Healthy Moms project ran the course of 2011, exploring the issue and identifying barriers. The more they worked, the more they became aware of similar efforts across Illinois. These efforts are now pooling their resources for a statewide steering committee, operating under the Healthy Babies, Healthy Moms name.
The committee will oversee and coordinate five key initiatives:
- Performance data infrastructure and public reporting of results
- Hospital elective delivery policies aligned with best practice
- Payment reform to align financial incentives with best practice (See What Payment Systems and Benefit Designs for Maternity Care Should Look Like in Illinois in Five Years, the findings of a recent payment reform workshop).
- Malpractice relief to align financial incentives with best practice
- Consumer education and outreach to increase knowledge of best practice for maternity care
Healthy Babies, Healthy Moms Team
Front row (sitting) (L-R): Lori Filock, Jenny Brandenburg, Dr. Rahmat Na'Allah, Tracey Arahood Back row (standing) (L-R): Robin Grubbs, Bonnie Paris, Darlene Hammond, Dr. Rick Horndasch, Dr. Gail Amundson, Allen Cooper
Participating organizations include:
Advocate BroMenn Medical Center in Normal
American Congress of Obstetricians and Gynecologists Illinois Section
Carle Foundation Hospital in Urbana
Decatur Memorial Hospital
Illinois Chapter of the March of Dimes
Illinois Hospital Association
Illinois State Medicaid
Memorial Hospital in Carthage
Methodist Medical Center of Illinois in Peoria
Midwest Business Group on Health
OSF Saint Francis Medical Center in Peoria
Peoria County Health Department
Rockford Health Systems
University of Illinois College of Medicine at Peoria