Early Elective Deliveries

Published February 2013

Early Elective Deliveries. The U.S. Department of Health and Human Services (HHS) estimates that even a 10 percent drop in baby deliveries before 39 weeks of gestation would lead to more than $75 million in annual Medicaid savings. The final weeks of pregnancy are important to a baby’s development, especially to allow the lungs and brain to fully mature. Elective deliveries by induction or Caesarean section may increase the risk of breathing and feeding problems and blood infections, which may require costlier hospital stays and cause long-term health conditions. Elective deliveries before 39 weeks of gestation have increased during recent decades; as many as 10 percent of all deliveries are scheduled without a medical reason during weeks 37 and 38. Mothers’ discomfort, convenience and physician schedules contribute to this increase. Complications from early elective deliveries affect state budgets; Medicaid pays for about 40 percent of all births in the United States.

To promote healthy pregnancies and newborns and to save Medicaid costs, some states have taken steps to reduce elective induction and Caesarean deliveries.

  • Since 2011, Illinois, New York, Texas and Washington have passed laws to reduce early elective deliveries. In 2011, for example, Texas enacted House Bill 1983 to prohibit Medicaid reimbursement to hospitals for early non-medically necessary deliveries. Washington appropriated $300,000 in 2011 (House Bill 2058) for the state Health Care Authority to develop guidelines for the appropriate and effective role of Caesarean sections and early induced labor.
  • In South Carolina, the Department of Health and Human Services’ Birth Outcomes Initiative worked with the hospital association to decrease early elective deliveries among Medicaid enrollees. The state estimates it will save about $1 million in delivery costs and $7 million from fewer hospitalizations each year.
  • In 2007, the Kentucky Department of Public Health partnered with the March of Dimes and Johnson & Johnson to launch the Healthy Babies Are Worth the Wait campaign with a goal to reduce all preterm births by 15 percent. The campaign promotes awareness among perinatal providers and pregnant women about the baby’s final weeks of development.


Sources: U.S. Department of Health and Human Services, 2012; March of Dimes, 2012; The Leapfrog Group, 2012; Association of Maternal and Child Health Programs, 2012.

United States map of the percent of late preterm births, 2011


























Source: B.E. Hamilton, J.A. Martin, and S.J. Ventura. "Births: Preliminary data for 2011." 61, no. 5. Hyattsville, MD: National Center for Health Statistics, 2012. Accessed Jan. 14, 2013 at National Vital Statistics Reports www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05_tables.pdf.
 

Additional Resources

Improving Babies' Health and Reducing Medicaid Costs
NCSL LegisBrief, June 2012

Pushing for Full-Term Births
NCSL State Legislatures Magazine, January 2013

Maternal and Child Health Overview
NCSL

Maternal and Child Health Bureau
Health Resources and Services Administration, U.S. Department of Health and Human Services

COIN: Using the Science of Quality Improvement and Collaborative Learning to Reduce Infant Mortality, Webcast
Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

Maternal and Child Health Bureau Region IV and VI Infant Mortality Summit 2012
Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services

Forging a Comprehensive Initiative to Improve Birth Outcomes and Reduce Infant Mortality: Policy and Program Options for State Planning
Association of Maternal and Child Health Programs, July 2012

President's Challenge 2012: Healthy Babies
Association of State and Territorial Health Officials

Strong Start for Mothers and Newborns Initiative
Centers for Medicare and Medicaid Services

Less Than 39 Weeks Toolkit
March of Dimes

Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation may Address Quality and Cost Issues
Health Affairs, March 2013

 

This webpage was adapted from an NCSL postcard published in February 2013.