texas has just passed House Bill 1983 which requires hospitals and physicians to limit elective deliveries (including both inductions and cesarean sections) prior to 39 weeks gestation unless medically indicated. As of September 1, 2011, Texas Medicaid will no longer reimburse hospitals for elective deliveries occurring before 39 weeks which are not medically necessary and properly documented as such.
An elective induction occurs when labor is started, with medication or by other means, per the mother or physician’s request for reasons of convenience rather than medical necessity. Elective induction reasoning examples include: mother is uncomfortable and no longer wishes to be pregnant, physician is going out of town and other scheduling conflicts.
There are instances when inductions or c-sections prior to 39 weeks gestation are necessary to protect the mother or infant’s health. The American College of Obstetricians and Gynecologists (ACOG) lists the following as appropriate reasons for indicated (necessary) inductions:
- Postterm pregnancy (past 41 weeks of gestation)
- High blood pressure caused by pregnancy
- Maternal health problems affecting the pregnancy
- Infection in the uterus
- Water has broken too early
- Fetal growth problems
Elective inductions and cesarean rates have dramatically increased since 1990 and the c-section rate in the US has soared to over 32%. Elective inductions prior to 39 weeks gestation increases the risk for a cesarean section and can have adverse health outcomes for the newborn.
Estimating the baby’s “due date” is not an exact science and may not always be accurate. Forty weeks gestation is used to calculate the due date, however, this date can be off by ± 2 weeks. “Term” refers to a baby born between 37 to 42 weeks gestation. A baby born even a week too early (< 37 weeks) can suffer from the many problems surrounding prematurity including respiratory problems, feeding problems and neurological problems. These babies tend to have prolonged hospital stays in the Neonatal Intensive Care Unit (NICU). NICU stays are expensive and can cost about $50,000 per infant1. It is estimated that approximately “$1 billion dollars could be saved annually in the US if the rate of early term delivery were reduced to 1.7%.2”
During the last weeks of pregnancy, a baby is still undergoing important developmental changes. This bill not only looks to cut the financial burdens incurred by the complications of early inductions, but also to protect the health of mothers and babies.
Curious how your hospital measures up? Find out your hospital’s rates of elective deliveries here.
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- Texas Association of Obstetricians & Gynecologists. HOUSE BILL 1983 SIGNED BY GOVERNOR: Hospitals and Doctors Must Limit Elective Deliveries Less Than 39 weeks
- The LeapFrog Group. FACT SHEET: Early Elective Deliveries (Between 37 and 39 Completed Weeks of Gestation)
ACOG. Healthy Women 2009: Elective Inductions
Barclay, L. Elective Repeated Cesarean Delivery at Early Term Linked With Adverse Events
Clark, S., et. al. Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics & Gynecology 2009; 200:156.e1-156.e4
Tita, A., et. al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. New England Journal of Medicine 2009; 360:111-120.
Author : Diba Tillery RN, BSN, IBCLC, CPST