Better Births, Lower Costs

Safer, less expensive maternity care is slowly taking hold.

America spends a larger percentage of its gross domestic product on health care than any other industrialized nation, yet its citizens aren’t healthier for it. This is especially true when it comes to childbirth. Having a baby is the No. 1 reason for hospitalizations in the U.S., and a Cesarean section is the most common operation. In 2006, $86 billion was spent on maternal and newborn hospital charges, but despite this spending, our infant mortality rate ranks 29th among industrialized nations and our maternal mortality rate is a dismal 36th. In 2008, the March of Dimes gave us a “D” for our work on preventing preterm births.

Experts have dubbed this phenomenon of doing more but accomplishing less the “perinatal paradox.” “Practices that have proved to make childbirth safer, easier and less expensive are underused, while costly interventions such as induction and repeat C-sections that may increase risks to mothers and babies are routinely overused,” says Maureen Corry, executive director of Childbirth Connection, a nonprofit group that promotes evidence-based maternity care.

Two Common Culprits Cesarean sections are a leader in driving childbirth-related spending, the Agency for Healthcare Quality reports. Nearly one-third of the 4.3 million childbirths in 2006 were via C-section, compared with one-fifth in 1997. A C-section costs an average of $4,500 versus $2,600 for an uncomplicated vaginal delivery; $6,100 versus $3,500 for a vaginal birth with complications.

Preterm births also contribute to expensive stays in the neonatal intensive care unit (NICU). Now there’s growing recognition that delivering even a few weeks early raises the risk of breathing and feeding problems and difficulty maintaining body temperature, says Sue Gullo, R.N., M.S., director of the Perinatal Community at the Institute for Healthcare Improvement (IHI) in Cambridge, Mass. “There’s a huge momentum to avoid scheduling elective C-sections or inducing labor before 39 weeks,” she says. IHI has worked with more than 200 hospitals to develop guidelines to improve maternity care and reduce costs and liability. It addresses careful use of oxytocin (Pitocin) to induce labor or help it along, better communication and restricting deliveries before 39 weeks.

Safer Practices Pay Off Insurers are jumping on the bandwagon, too. United Healthcare found that 48 percent of newborns admitted to the NICU were from scheduled deliveries, many of them before 39 weeks. When doctors and hospitals curbed the practice, the insurer saw a 46 percent decline in NICU admissions in just three months. “They realize that it costs them a lot more when the safest place for the baby to be is still inside the mother,” says Gullo.

While it’s encouraging that more health care players are changing their practices, women need to recognize their role as well, Gullo says. “Ask questions,” she urges. “Be informed. Patients are a crucial part of the checks-and-balances process that’s needed.”

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