Improving Maternal and Child Health Review

Elective Delivery

The Publication and the Issue that it Presents

The article entitled Born too early: Improving Maternal and Child Health by Reducing Early Elective Deliveries was published on NIHCM Foundation, Transforming Health Care Through Evidence and Collaborations. The article discusses the issue of possible negative health consequences that early elective deliveries poses on infants, mothers and on health care system collectively, along with additional costs as an unnecessary burden. Infants might face an increased risk of:

Poorer brain mass.

Respiratory Distress Syndrome (RDS).

Low birth weight.

Feeding problems.

Longer stay at hospital.

While mothers face an increased risk of:

Cesarean delivery.

Post-delivery depression.

Longer stay at hospital due to complications.

Price to the Health Care System:

Early Elective Deliveries (EED) are linked to an increased risk of cesarean delivery, which costs about 50% more than the costs of vaginal births, on an average. Moreover, premature infants, born before 39 weeks, are susceptible to get admitted to Neonatal Intensive Care Unit (NICU) at a substantial increased expense for both Medicaid and commercial insurers (NIHCM Foundation, 2014).

2. The type of health care organization that I would like to work for in the future and the implications of this issue to that organization and to at least two groups of its stakeholders

I would like to work for National Child & Maternal Health Education Program (NCMHEP) in the future. To reduce elective deliveries, NCMHEP is educating doctors and patients about the risks accompanying electric delivery before 39 weeks. The first step was to educate healthcare professionals. They developed a course of Continuing Medical Education (CME) for nurses and doctors to discuss the newest research and best practices about reducing elective deliveries (Shriver, 2013).

The two other stakeholders discussed here are BlueCross BlueShield of South Carolina (BCBSSC) and South Carolina Hospital Association.

BlueCross BlueShield of South Carolina (BCBSSC)

In July 2011, BlueCross BlueShield of South Carolina (BCBSSC), in partnership with South Carolina Department of Health and Human Services and many other organizations, made an effort to reduce EEDs, which is known as the Birth Outcomes Initiative (BOI). The focus of BOI was to achieve goals like:

Termination of elective induction without medical indications prior to 39 weeks.

Reducing health differences among new-borns and promoting breastfeeding.

Reduction of average length of stay at NICUs.

Making 17P accessible to all pregnant women at-risk.

Employing a universal screening and referral tool (SBIRT), that will screen pregnant women for tobacco use, domestic violence, depression and substance abuse (BCBSSC, 2014).

South Carolina Hospital Association

South Carolina Department of Health and Human Services (SCDHHS) worked diligently with the South Carolina Hospital Association (SCHA) in the process of procuring letters from the hospitals, which agreed to terminate the practice of early deliveries. Additionally, Birth Outcomes Initiative (BOI) in collaboration with SCHA, patients, other state agencies, suppliers and insurers, is working to achieve goals like:

Easy access to affordable progesterone treatment to reduce preterm births.

Employment of screening tool to screen pregnant women.

Recognizing and targeting health discrepancies amongst minority populations (March of Dimes, n.d.)

Some of the questions that one would need to ask, resources one might need to access, or actions one would take to prepare his organization for change or to exploit opportunities

The said discussion about EEDs very well answers to some questions like ‘will this agreement to end EEDs decrease cesarean deliveries?’ or ‘what tools are present in California for expectant mothers?’ or ‘what can be done to educate expectant mothers about EEDs?’ and indicates the decreasing rate of EEDs in South Carolina. Now, one can take certain actions to prepare his/her organization by:

Maintaining documentation requirements for early deliveries, in medical record.

Generating a scheduling form to check estimated gestational age on due date of delivery and medical indication for deliveries prior to 39 weeks.

Making sure how far in advance induction can be planned.

Electing experienced OB nurses to schedule cesarean deliveries and inductions.

Making sure that office practice schedulers establish consistent communication with expectant mothers in all their interaction with the system (National Quality Forum, 2014, 8-9).

Educating their doctors and expectant mothers about the risks involved.

Waiting as long as possible against a cesarean delivery, unless medically indicated.

Response to the two of the following questions:

a. Do you see changes arising from this situation to be a boon to patients? Why or why not?

No known benefits for EEDs have been recorded yet; however, the risks it includes for mother and baby are noteworthy. Infants born at <39 weeks might suffer serious health complications due to underdeveloped vital organs like the brain, liver and lungs. As per studies, about 50% of cortical volume growth takes place between 34-40 weeks. Moreover, the infant’s brain, at 37 weeks, weighs only 80% of the brain of an infant born at 40 weeks (Astho, 2014).

b. Do you think that government will create regulation relating to this topic that you will need to comply with?

Private and government insurers have started penalizing hospitals for EEDs, while some of them are giving rewards to limit the same. In 2012, the state asked hospitals to modify their policies for inducing labor, which decreased the EED rate from 9% to 4.6% as a result. The federal government has also started to reform payments for EEDs through Medicare. While Tony Keck, the director of state’s health and human services, declared that if voluntary effort was unsatisfactory, the state would discontinue paying reimbursements to hospitals for these deliveries. The expenses directly controlled by the South Carolina’s government were of Medicaid only (Rosenberg, 2014).


Astho. (2014). Issue Brief: Early Elective Delivery. Association of State and Territorial Health Officials. Retrieved from

BCBSSC. (2014). Birth Outcomes Initiatives: Claims Coding. Live Fearless BlueCross BlueShield of South Carolina. Retrieved from

March of Dimes. (n.d.). SC Hospitals and Medicaid Partner to Reduce Preterm Births. Retrieved from (1).pdf

National Quality Forum. (2014). Playbook for the Successful Elimination of Early Elective Deliveries. NQF Maternity Action Team. Retrieved from

NIHCM Foundation. (2014). Born too early: Improving Maternal and Child Health by Reducing Early Elective Deliveries. Retrieved from

Rosenberg, T. (2014). Reducing Early Elective Deliveries. The New York Times. Retrieved from

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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