Insurer: Rethink C-sections

Colorado's second largest health insurer is urging pregnant women and their doctors to reconsider Caesarean sections unless they're medically necessary.

This week, UnitedHealthCare reported that its claims data indicate babies born via Caesarean section before 39 weeks of gestation are twice as likely to require neonatal intensive care as those delivered vaginally.

The finding comes at a time when C-sections are being performed in record numbers, often when they are medically unnecessary. UnitedHealthcare, which conducted the analysis based on a review of claims data from mothers and newborns, says the information should discourage patients and physicians from choosing C-sections without compelling medical reasons, especially before 39 weeks.

The insurer, which has 670,000 members in Colorado, doesn't plan to change its reimbursements to physicians who perform C-sections or alter out-of-pocket expenses for patients who get them, said Dr. Chris Stanley, senior medical director for UnitedHealthCare's Colorado division.

Instead, UnitedHealthcare is trying to get the word out about the risks of C-sections and is including the data in its educational materials for patients and physicians.

Some mothers elect to have C-sections to choose a birthdate, while doctors sometimes perform them as a safeguard against malpractice suits, according to Childbirth Connection, a national nonprofit that works to inform women on maternity issues.

Guidelines by The American College of Obstetricians and Gynecologists recommend against elective C-sections before 39 weeks, but not all physicians are aware of the guidelines or understand the implications, said Dr. Chris Stanley, senior medical director for UnitedHealthCare's Colorado division. Often decisions to perform C-sections are not black-and-white, and he hopes the insurance company'sdata will serve as a resource during those times when a physician might be indecisive.

In an accompanying pilot study by UnitedHealthCare, physicians and hospitals that altered their practice regarding such C-sections saw a 46 percent decrease in Neonatal Intensive Care Unit admissions in the first three months.

"Reducing the overall number of elective Caesarean sections would significantly decrease health risks for mothers and their newborns," said Tina Groad, the national medical director for UnitedHealthcare's Women's Health, in a news release.

In 2006, thenational C-section delivery rate rose to a record 31.1 percent of births, a 50 percent increase over the last decade, according to the Centers for Disease Control and Prevention's statistical arm, the National Center for Health Statistics. More than half of C-sections are medically unnecessary, UnitedHealthcare said, citing the federal Agency for Healthcare Research and Quality.

The group hopes the information will improve patient care and reduce the costs associated with visits to the NICU.

Dr. Laura Klein, a doctor who specializes in high-risk pregnancies for Pikes Peak Maternal Fetal Medicine at Memorial Health System, said she's not surprised by the information. For natural births, 37 weeks is considered full term. But certain biological processes occur in natural births that don't occur during C-sections, so 37 weeks for a vaginal birth is not the same as for a C-section, and those babies often need help with breathing and lung development.

Often, babies delivered by C-section before 39 weeks need just a stay of a few days in the NICU to receive extra oxygen and monitoring. But Klein recalled one case in which a baby required a ventilator and later died.

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Contact the writer: 636-0198 or brian.newsome@gazette.com