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Elective C-Sections Banned Prior to 39 Weeks of Pregnancy

New state law to save in Medicaid costs & protect health of mothers and babies

Today University Health System and March of Dimes told reporters about a new Texas law signed by Governor Rick Perry this year that will initiate cost-cutting measures for reducing Medicaid deliveries not proven to be medically necessary.

March of Dimes has been lobbying Texas lawmakers to pass this legislation to help as many babies as possible be carried to full-term. A surprisingly number of moms-to-be and doctors have been making the decision to deliver before 39 weeks gestation, even though babies are at much higher risk for dying or suffering serious complications, including feeding, respiratory complications, jaundice, and other ailments.

Donald Dudley, MD, University Hospital, Chair of the Texas Quality Improvement Committee, March of Dimes and Professor, UT Health Science Center School of Medicine, Dept. of OB/GYN, said, “Babies born at full-term (39-41 weeks) have the very best outcomes, with the lowest rates of NICU admissions, lowest rates of neonatal death, and lowest rates of other diseases of prematurity."

The gestational age of the fetus should be determined at least 39 weeks. When a delivery occurs before that, the maternal and fetus conditions must dictate medical necessity for delivery of babies.

Dr. Dudley explained, “Babies are still undergoing important developmental changes during the final weeks of pregnancy. “I firmly believe that babies should be given the best possible chance to grow up and do well. And the best way to do this is to get the very best possible outcome for each and every pregnancy.”

He said the main risk from c-sections prior to 39 weeks is neonatal death from complications of prematurity. “But the next main risk and cost for babies born too early is abnormal and delayed brain development, including increased risks for cerebral palsy.”

In addition to the risks involved, Dr. Dudley said the financial cost to the healthcare system is enormous. The care of preterm babies in the NICU is the single biggest financial cost in pregnancy and newborn care.

However, with the passage of House Bill 1983, Texas Medicaid will no longer reimburse hospitals for elective c-sections occurring before 39 weeks, unless they are proven to be medically necessary. If these deliveries aren’t considered necessary, they will be denied.

The number of elective cesarean rates has dramatically increased since 1990; currently more than 32 percent of deliveries are by c-section. Texas health officials estimate the ban will save the state over $36 million in Medicaid costs. Cesarean section babies also tend to have prolonged and expensive hospital stays in the Neonatal Intensive Care Unit (NICU).

“One of the main potential benefits of programs that have been successful at decreasing the rates of elective early term births is a decrease in the rates of NICU admissions,” explained Dr. Dudley. “About 10-15 percent of women delivered electively from 37-39 weeks and have their babies get admitted to the NICU, and the majority of these babies do not go home with their moms, so maternal/infant bonding can be impaired.”

Aside from reducing cost, University Health System and March of Dimes officials applaud the bill for protecting the health of mothers and their babies.

Dr. Dudley added, “If the rates are lowered for cesarean sections, the overall maternal outcomes will be greatly improved.”

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