What to Elect When You’re Expecting

By Sarah Sipek

May. 25, 2015

Preparing to have a baby is a major life event. Over the course of nine months, a crib must be bought, a name must be chosen and a nursery must be painted. While expectant mothers likely won’t look to their employers to help decide whether to go with cloth or disposable diapers, female employees can and should turn to their employers when it comes time to make decisions that will affect their own health as well as that of their newborn child.

One of the areas where an employer can effectively intervene is the delivery.

According to The Leapfrog Group, a nonprofit organization that promotes safety in health care by giving consumers data to make informed health care choices, many women are underinformed when it comes to the physical process of childbirth. One of the biggest mistakes that pregnant women make, the group says, is choosing to have an early elective delivery — a scheduled cesarean section or medical induction performed prior to 39 weeks of gestation without any medical necessity.

A C-section is the riskier of the two procedures and involves making one or more incisions through the mother’s abdomen and uterus to deliver a baby. Medical inductions use hormones to stimulate labor before it naturally occurs.

“Any time there is a surgical incision, there is a risk involved,” said Dr. Jennifer Schneider, chief medical officer at Castlight, a San Francisco-based health care technology company. “These include infection and poor healing.”

The American College of Obstetricians and Gynecologists lists blood loss, blood clots in the lungs and legs and bowel constriction as possible risks to the mother. Infants often require neonatal intensive care because of the underdevelopment of their lungs.

Despite the risks, some hospitals continue to perform high-risk elective deliveries. The Leapfrog Group began tracking high-risk procedures and maternity care in 2010. That year, it found that the national average for early elective deliveries was 17 percent. The results of its 2014 survey on maternity care found that the national average for elective deliveries has declined to 3.8 percent as a result of efforts to educate women. However, only 24.4 percent of hospitals surveyed met The Leapfrog Group’s preparedness standards for infants born in high-risk, elective settings.

According to Schneider, hospitals that do not comply with standards set forth by the American College of Obstetricians and Gynecologists and other governing bodies do so in order to stick to traditional 9-to-5 business hours. For example, a woman struggling to deliver on a Friday afternoon may be induced so that the delivery doesn’t carry over into the weekend.

Practices like these put mothers at risk and reduce hospital ratings — reasons that employers should make sure their female employees or family dependents have access to information about the risks and which hospitals are the safest.

“Employers have done a lot to make sure that all of their childbearing-aged women are aware that these ratings exist,” said Erica Mobley, director of communications at The Leapfrog Group. “Just from an educating standpoint, making women aware that they can locate procedure rates and make better choices when it comes to deciding the safest hospital to deliver at.”

From an employer standpoint, this involves creating platforms where data from The Leapfrog Group as well as federal agencies including Medicaid can be easily accessed. Providing this information is good for more than just higher employee engagement scores, though. Employers can expect measurable declines in health care costs as a result of this simple intervention.

Maternity care ranges from $3,000 to $40,000 for an uncomplicated vaginal delivery. According to a 2014 study conducted at the University of California at San Francisco, those rates double for C-sections. Of course, there are times when a C-section is necessary, according to the March of Dimes, such as if a C-section was performed during a previous pregnancy, the baby is too big for vaginal delivery or if the baby is in a breech position.

“To take that to a greater extent, employers can also work with their health plans to design networks so that women are going to the best hospitals for maternity care,” Mobley said. “Whether that’s working with the health plan to reduce the deductible at a hospital that is doing well, or imposing a penalty for going to a hospital that did not score well, there are lots of ways that employers can work with their health plan providers to try and steer women to the highest performing hospital.” 

To the advantage of both mother and employer, there is plenty of time to intervene effectively.

“Maternity care is really unique in that it’s one of the few areas in which you have a lot of time to think about and prepare for a hospital stay,” Mobley said. “It’s important for women and employers to take advantage of that opportunity and carefully consider what hospitals they have available so that they can pick the best one.”

Sarah Sipek is a Workforce associate editor.

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