The XX Factor

A Lot Fewer American Women Are Choosing to Give Birth Early, Thanks to Obamacare

It’s best not to rush this.

Cameron Whitman/ Thinkstock

In 2010, 17 percent of babies in the United States were born by way of early elective deliveries, which are medically unnecessary induced or C-section deliveries done between weeks 37 and 39. Such deliveries carry serious risks. Babies born within this period are 50 percent more likely to end up in the neonatal intensive care unit than babies born after 39 weeks and are more likely to develop cerebral palsy, vision and hearing loss, and learning difficulties, and even to die.* Infant mortality is at least 50 percent higher for babies born at 37 or 38 weeks compared to those born at 39 or 40. Also, even though many moms are over playing host in their last month of pregnancy, the babies inside of them still have some growing to do. A baby’s brain develops the fastest at the end of pregnancy, and grows by one-third between week 35 and week 39. They also tend to fatten up during this period, which helps them stay warm after exiting the womb.

Elective early deliveries are expensive, too. According to the March of Dimes, babies born in this period tend to stay in the hospital longer and cost an average of $7000 more than a baby born between 39 and 41 weeks. If the baby is born via C-section or ends up in the intensive care unit, that figure is likely to be higher.

When the Affordable Care Act launched in 2010, it funded a two-part initiative called Strong Start for Mothers and Newborns aimed at reducing the high rate of preterm births in the United States. The first phase of this project, a collaboration between Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Administration for Children and Families, is a program designed to reduce unnecessary preterm births—and promising data released this week suggest that it’s working. (The other phase of the initiative, which is still in early stages, is to test new approaches to prenatal care with the goal of reducing necessary preterm births.)

According to the American Congress of Obstetricians and Gynecologists, common reasons for early delivery include the physical discomfort of late-stage pregnancy, a fear of vaginal birth (in the case of elective C-sections), or wanting to schedule the birth of a baby on a specific date for the sake of convenience. Over the past six years, Strong Start for Mothers and Newborns has been working to educate mothers and medical professionals about why it’s worth it to wait for labor. They’ve also pushed hospitals to collect data on the number of elective deliveries they perform—information many of them weren’t collecting before 2010. The data paint a dramatic picture. According to a new report from U.S. Department of Health and Human Services, between 2010 and 2013, there was a 70.4 percent reduction in early elective deliveries among participating hospitals. By May 2014, more than 25,000 early elective deliveries were prevented. These findings dovetail with those found by The Leapfrog Group, an employer-backed nonprofit that tracks hospital safety and quality, who found that the national early elective delivery rate dropped to 2.8 percent in 2015—down from the aforementioned 17 percent in 2010.

The Strong Start for Mothers and Newborns program isn’t the only reason for the steep drop in elective deliveries. Other initiatives have almost certainly had an effect, too, including programs in Texas and South Carolina that barred their state-funded Medicaid programs from reimbursing hospitals for early elective deliveries. Overall awareness about the dangers of early delivery has also increased thanks to academic articles and The Leapfrog Group’s decision to document the rates.

The campaign against elective deliveries is just one of the positive changes the Affordable Care Act has made to prenatal care. Prior to 2014, when it became illegal for individual and small group policies not provide maternity coverage, only 12 percent of market plans covered such care. (As for larger group policies, the 1978 Pregnancy Discrimination Act mandated that employers with 15 or more employees who provide health insurance must include maternity benefits.) The ACA also required that insurance covers preventive services like gestational diabetes screening, as well as breastfeeding support and supplies and newborn care.

Still, having a baby with Obamacare is no cakewalk. The Billfold’s Ester Bloom wrote about how the high deductibles on her exchange plan forced her to be very careful about which tests were necessary and which weren’t, to avoid paying too much out of pocket. Also, getting pregnant is not a qualifying event, which means that if an uninsured woman gets pregnant, she must wait until the next enrollment period to sign-up. Enrollment periods happen only once a year for a three month period, so a woman could hypothetically find out she is pregnant after one open enrollment period and have a baby before the next one. Women’s health advocates are trying to change this, and last year Senator Sherrod Brown (D-OH) and Rep. Bonnie Watson Coleman (D-NJ) sponsored the Healthy Maternity and Obstetric Medicine Act. This bill would create a Special Enrollment Period for pregnant women to enroll in coverage offered by plans in state and federal marketplaces, employers, or the federal government. It is currently under review in the Senate Finance Committee, and, if passed, it would make Obamacare’s improvements to prenatal and neonatal health even stronger.

Correction, June 27, 2016: This post originally misstated that babies born between weeks 37 and 39 have a 50 percent chance of ending up in the neonatal intensive care unit.