Early Induction of Labor Leads to Bad Outcomes and Excess Costs

Today’s Managing Health Care Costs Indicator is $5.5 Billion

Jane Brody’s New York Times column last week was about the March of Dime’s new campaign to discourage early induction of labor.   She points out that babies delivered early have more lung, liver and infection problems.  She cites a factoid that should discourage all women from early inductions, the fetal brain gets 50% larger between the 35th week and the 39th week of pregnancy. 

Early induction of labor is more likely to lead to Caesarian section – and one in three deliveries in the United States are now by C Section.  C- Sections cost about 50% more than vaginal births, and so the 1.3 million Caesarian sections in the US each year cost in excess of $5.5 billion more than if these deliveries were vaginal.

Avoidable Caesarian sections are especially harmful for those women who will go on to have three or more children.   There was a recent painful case study in the New England Journal  of a woman with placenta accreta (where the placenta adheres to the uterus, leading to life-threatening blood loss) which pointed out that the likelihood of such placental abnormalities goes up dramatically with subsequent Caesarian sections.

The Leapfrog Group recently started reporting on self-reported rates of elective induction prior to 39 weeks, and the National Quality Forum has endorsed an administrative quality measure that identifies low risk first deliveries that are done via caesarian section.  We need more transparency efforts like this, as well as patient education programs like those of the March of Dimes to discourage requesting early deliveries.   We also need payment reform to encourage patience to increase the portion of deliveries performed vaginally. This includes full payment for the services of midwives, who are less likely to refer their patients for surgical delivery.

It’s time for us to stop delivering babies before they are ready!