Intermountain shares trends of 300,000 births over 10 years

Nearly $3.5 billion in annual medical charges could potentially have been avoided if the nation's Caesarean section rate was similar to that of Intermountain Healthcare. In fact, every one percent decrease in the nation's C-section rate could save more than $300 million in maternal charges, according to data from the AHRQ-HCUP of the U.S. Department of Health and Human Services.

When comparing 2008 data — the most current national statistics available — Intermountain saved patients nearly $50 million that year when comparing its C-section rate (21 percent) with the national rate (32 percent). These savings only represent hospital charges and do not include physician, anesthesia, or other fees or any readmission, follow-up care, etc. that add to healthcare costs. By keeping its C-section rate below the national average, Intermountain estimates it has lowered charges to patients by more than $270 million over a ten year period.

Unnecessary C-sections and pre-term inductions are considered major examples of medical "overtreatment" adding significant cost and increased medical risk to patients. In a 10-year report by Intermountain Healthcare, clinicians share trends from more than 300,000 births at 19 Intermountain hospitals which are primarily located in Utah — a state with one of the highest birthrates in the nation.

Nationally, about 1 in 3 births are by C-section — the most common surgery in U.S. hospitals today. This represents an all-time high, increasing by more than 50 percent since the 1990s. In 2008, Intermountain estimates that 473,592 C-sections in the U.S. were potentially unnecessary. These births result in higher (national) average maternal charges — $16,671.89 compared to $9,428.08 for a vaginal birth — and increased medical complications for the mother and baby. (Intermountain's average charges were $9,101.35 for a C-section and $4,964.30 for a vaginal birth.)

About 10 years ago, Intermountain noticed a striking trend that was part of a larger national phenomenon. "Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age," said D. Ware Branch, MD, medical director of Intermountain's Women and Newborns Clinical Program. "We were concerned that early inductions might have negative health consequences for babies and moms."

"When we analyzed the data from births at Intermountain's hospitals, we found that women who deliver before babies reach 39 weeks gestational age tend to have longer and more complicated deliveries, an increased proportion of which lead to more C-sections," Branch said. "We also found an increase in the number of newborns with medical complications in the group delivered before 39 weeks."

This led to efforts to implement guidelines to reduce elective inductions before 39 weeks — the ideal gestational period. In 1999, approximately 28 percent of all inductions at Intermountain's hospitals occurred before 39 weeks. Today, that percentage is under 2 percent. And with the significant drop in early elective inductions, Intermountain has also seen a drop in the average length of labor, fewer C-sections, and a reduction in certain newborn complications in electively induced patients. The cost implications are substantial — Intermountain hospitals deliver more than 33,000 babies every year.

Branch emphasized that Utah's overall cesarean section rate is low, in fact, one of the lowest in the U.S. "Some of this is due to the good obstetric practice of the physicians in Utah and Intermountain Healthcare has been at the forefront of improving the quality of obstetric care in the region," he said. "However, we have our challenges. Maintaining good practice is a continuing challenge for all of us, including Intermountain Healthcare."

Patients should talk to their providers to understand the benefits of not inducing labor before babies reach 39 weeks gestational age, said Branch. "Following our guidelines continues to benefit new babies and their moms. And as icing on the cake, it has also saved patients tens of millions each year."