Blue Cross and Blue Shield of Louisiana and Louisiana Medicaid are no longer paying for medically unnecessary births before the 39th week of pregnancy.
State medical leaders cited infant health as the reason for the decision during a formal announcement at Woman’s Hospital in Baton Rouge on Wednesday.
“We know this change will help reduce complications for our children and their mothers,” Louisiana Department of Health and Hospitals Secretary Kathy Kliebert said. “Our children deserve that time and that opportunity to fully develop before birth.”
Elective deliveries before 39 weeks, either through induced labor or cesarean section, have been a topic of interest among the medical community for some time. Pregnancy typically lasts about 40 weeks but can stretch to 41. Doctors say some women turn to the early elective procedure for the convenience of avoiding an inconvenient labor.
Those who want to curtail early elective births say that they lead to longer — and costlier — hospital stays, as well as increased health risks for mothers and babies.
For more than three decades, the American College of Obstetricians and Gynecologists has discouraged elective deliveries before the 39th week, but, according to a 2009 medical study recently cited by the U.S. Department of Health and Human Services, about 10 to 15 percent of births in the United States each year are performed prior to that and without a medical reason.
Starting this month, Blue Cross will not cover elective deliveries, either C-section or induced natural birth, before the 39th week of pregnancy but will continue to cover those early births that are deemed medically necessary.
Under the state Medicaid change that took effect July 1, the legacy Medicaid and Bayou Health plans will not reimburse providers for early elective deliveries before 39 weeks, but will cover those that are medically necessary.
Woman’s, in 2007, became one of the first hospitals in the state to bar early elective deliveries before 39 weeks. According to Fontenot, the hospital saw a 20 percent drop in the number of critically ill newborns that had to be admitted to the Newborn and Infant Intensive Care Unit. First-time C-section rates dropped 3 percent, she said.
“Our efforts have saved our patients and the taxpayers of Louisiana millions of dollars,” Woman’s Hospital Chief Quality Officer Dr. William Binder said.
Dr. Alfred Robichaux, chairman of the Department of Obstetrics and Gynecology at Ochsner Health System, said Ochsner’s Southeast Louisiana hospitals also are among those that have signed on to the state’s voluntary “39-Weeks Initiative,” which began in 2012 as an effort to cut back on early elective deliveries.
DHH Medicaid Medical Director Dr. Rebekah Gee said she has seen women use various excuses for seeking early deliveries, but she said it most often boils down to convenience.
“Things I’ve heard for convenience were, ‘I needed to be able to fit into that bridesmaid’s dress,’ ‘I wanted to get on to my vacation scheduled three weeks from now,’ ‘My Aunt Sandy is in town and we wanted to have the baby then,’ ” Gee said. “Those are not good reasons to have a baby early.”
In some areas across the country, physicians have resisted steps to curb early elective deliveries, saying the matter should be between doctors and patients.
Some have argued that pregnant women who live in remote locations far from hospitals where they will have their babies should be able schedule deliveries, as should their doctors.
But Gee said she thinks the health risks outweigh those concerns.
“A baby in a NICU with a feeding problem or a breathing problem is not worth the convenience of an early elective delivery,” she said.
Gee said she advises that women have that conversation with their obstetricians and plan.
“What we don’t want is for people to have an early delivery for no reason at all, other than convenience,” Gee said.