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December 6, 2012

Hospital incentives help babies determine own birth dates

The evidence has been in for some time. Scheduling births may be convenient for physicians, hospitals and expectant parents, but it generally isn't good for the health of mothers and children. It's expensive to boot.

To get a baby to arrive on schedule, doctors often perform a cesarean section, the most common surgery in the United States Since 1996, C-section rates have risen every year to 33 percent of all births in 2009. According to the World Health Organization, the right figure for any country is about 15 percent. The desire to deliver by appointment also prompts doctors to induce labor, for instance by injecting mothers with a hormone or breaking the amniotic sac. Induction rates have doubled over two decades to 23 percent in 2009.

These procedures are sometimes medically necessary — a cesarean, for instance, when the baby is in the breech position, or induction when the baby is more than two weeks overdue. Their elective use, however, has contributed to babies being born too early. From 1990 to 2009, the percentage of U.S. babies delivered at 37 to 38 weeks increased from 19 percent to 27 percent. These newborns aren't technically premature, but a growing body of research shows they are vulnerable. According to a study published last year, children born at 37 weeks are twice as likely to die in their first year as those born at 40 weeks. They have significantly more health problems as well.

These complications tax the health system. Weak newborns often wind up in neonatal intensive care units, which can cost $2,500 a day. Even when all goes well, a cesarean section, because it is surgery, costs 60 percent more than a vaginal delivery, averaging $24,300 versus $15,200.

As hospitals and insurers struggle to contain expenses, a confluence of interests emerges. By reducing elective birth interventions, providers and insurers can cut costs while mothers and newborns achieve better health.

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