Early Elective Deliveries: Health Risks and Policy Responses
This paper examines the issue of early elective deliveries (EEDs) — births induced before 39 weeks without medical indication — and the health risks they pose to infants, mothers, and the healthcare system. Drawing on a NIHCM Foundation report, the paper identifies infant risks such as respiratory distress, low birth weight, and prolonged NICU stays, as well as maternal risks including cesarean delivery and postpartum depression. It then considers how the National Child and Maternal Health Education Program (NCMHEP), BlueCross BlueShield of South Carolina, and the South Carolina Hospital Association are responding to EEDs. The paper concludes by evaluating whether EED reductions benefit patients and discussing emerging government regulations and reimbursement reforms.
- Overview of the Publication and Its Core Issue: Health and financial risks of early elective deliveries
- Stakeholder Responses to Early Elective Deliveries: NCMHEP, BCBSSC, and SCHA initiatives to reduce EEDs
- Preparing Organizations for Change: Practical steps organizations can take to reduce EEDs
- Patient Benefits and Government Regulation: Whether EEDs benefit patients and emerging regulations
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What makes this paper effective
- Clearly organizes complex health policy content using structured lists that make risks to infants, mothers, and the healthcare system immediately legible.
- Grounds the analysis in named, real-world stakeholders — NCMHEP, BCBSSC, and SCHA — giving the policy discussion concrete institutional specificity.
- Incorporates quantitative evidence (e.g., EED rate dropping from 9% to 4.6%; brain weight at 37 vs. 40 weeks) to support claims about both risk and policy effectiveness.
Key academic technique demonstrated
The paper demonstrates stakeholder analysis as an academic technique: it identifies distinct groups (insurers, hospital associations, educators, government agencies) and traces each group's specific role and interests in addressing a shared public health issue. This approach moves beyond describing a problem to mapping the ecosystem of actors responsible for solving it.
Structure breakdown
The paper opens by summarizing the source article and cataloging health and financial risks. It then introduces the type of organization the author aspires to work for and analyzes two additional stakeholders and their initiatives. A practical section follows on organizational preparation for change. The paper closes with two reflective questions — one on patient benefits, one on government regulation — answered with supporting evidence from the literature.
Overview of the Publication and Its Core Issue
The article entitled Born Too Early: Improving Maternal and Child Health by Reducing Early Elective Deliveries was published by the NIHCM Foundation, an organization focused on transforming health care through evidence and collaboration. The article discusses the possible negative health consequences that early elective deliveries pose to infants, mothers, and the healthcare system as a whole, as well as the additional costs they impose as an unnecessary burden.
Infants born before 39 weeks face an increased risk of:
- Poorer brain mass development
- Respiratory Distress Syndrome (RDS)
- Low birth weight
- Feeding problems
- Longer hospital stays
Mothers face an increased risk of:
- Cesarean delivery
- Post-delivery depression
- Longer hospital stays due to complications
Early Elective Deliveries (EEDs) are also linked to substantially higher healthcare costs. Cesarean deliveries, which are more likely to result from EEDs, cost approximately 50% more than vaginal births on average. Moreover, premature infants born before 39 weeks are more likely to be admitted to a Neonatal Intensive Care Unit (NICU), representing a significant increase in expense for both Medicaid and commercial insurers (NIHCM Foundation, 2014).
Stakeholder Responses to Early Elective Deliveries
The National Child and Maternal Health Education Program (NCMHEP) is an organization well positioned to address the problem of early elective deliveries. To reduce EEDs, NCMHEP educates both physicians and patients about the risks accompanying elective delivery before 39 weeks. The first step was to educate healthcare professionals. NCMHEP developed a Continuing Medical Education (CME) course for nurses and doctors to discuss the most current research and best practices for reducing elective deliveries (Shriver, 2013).
Two additional stakeholders engaged in this effort are BlueCross BlueShield of South Carolina (BCBSSC) and the South Carolina Hospital Association.
BlueCross BlueShield of South Carolina (BCBSSC)
In July 2011, BlueCross BlueShield of South Carolina (BCBSSC), in partnership with the South Carolina Department of Health and Human Services and several other organizations, launched an initiative to reduce EEDs known as the Birth Outcomes Initiative (BOI). The goals of the BOI included:
- Termination of elective induction without medical indication prior to 39 weeks
- Reducing health disparities among newborns and promoting breastfeeding
- Reduction of average length of stay in NICUs
- Making 17P (progesterone treatment) accessible to all at-risk pregnant women
- Employing a universal screening and referral tool (SBIRT) to screen pregnant women for tobacco use, domestic violence, depression, and substance abuse (BCBSSC, 2014)
South Carolina Hospital Association
The South Carolina Department of Health and Human Services (SCDHHS) worked closely with the South Carolina Hospital Association (SCHA) to obtain commitments from hospitals agreeing to end the practice of early elective deliveries. Additionally, the Birth Outcomes Initiative (BOI), in collaboration with SCHA, patients, state agencies, suppliers, and insurers, pursued goals including:
- Ensuring easy access to affordable progesterone treatment to reduce preterm births
- Employing a standardized screening tool for pregnant women
- Identifying and addressing health disparities among minority populations (March of Dimes, n.d.)
References
Astho. (2014). Issue brief: Early elective delivery. Association of State and Territorial Health Officials. Retrieved from
BCBSSC. (2014). Birth Outcomes Initiatives: Claims coding. BlueCross BlueShield of South Carolina. Retrieved from http://web.southcarolinablues.com/providers/providernews/2014providernews.aspx?article_id=602
March of Dimes. (n.d.). SC hospitals and Medicaid partner to reduce preterm births. Retrieved from
National Quality Forum. (2014). Playbook for the successful elimination of early elective deliveries. NQF Maternity Action Team. Retrieved from http://www.leapfroggroup.org/sites/default/files/Files/mat_eed-playbook.pdf
NIHCM Foundation. (2014). Born too early: Improving maternal and child health by reducing early elective deliveries. Retrieved from http://www.nihcm.org/component/content/article/5-issue-brief/1280-born-too-early-issue-brief
Rosenberg, T. (2014). Reducing early elective deliveries. The New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2014/03/12/reducing-early-elective-deliveries/
Shriver, E. K. (2013). About the NCMHEP and the initiative to reduce elective deliveries before 39 weeks of pregnancy. National Child & Maternal Health Education Program. Retrieved from
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