Survey Results Raise Concerns about Women’s Perceptions on Risks Associated with Elective Deliveries

Results of a national survey point to a greater need to educate women on the risks associated with early elective cesarean sections and labor inductions.

A recent survey by UnitedHealthcare of first-time mothers found more than half the respondents believe it is safe to deliver their baby before 37 weeks’ gestation even if not required because of a medical complication. However, the American College of Obstetricians and Gynecologists (ACOG) recommends that scheduled deliveries occur after 39 weeks’ gestation. Rates of early births (between 34 and 36 weeks’ gestation) are on the rise, despite ACOG’s recommendations and studies showing that babies born between 34 and 36 weeks are more likely to die than full-term infants and, if they survive, are more likely to develop cerebral palsy and have developmental delays than babies born full term.^2,3

The survey was created to gauge women’s understanding of the benefits of full-term pregnancy and the gestational age at which it is safe to deliver a healthy baby. The national survey interviewed 650 insured, first-time mothers from varied geographic, ethnic and socioeconomic backgrounds.

Survey results reveal that many women believe a full-term pregnancy is reached before 37 weeks and that an elective delivery does not require waiting until 39 weeks’ gestation. More than half the respondents believe it is safe to deliver before 37 weeks’ gestation, while more than 92 percent indicate safe delivery before 39 weeks. Further, 24 percent believe full term is reached before 37 weeks’ gestation, and a majority of respondents – 73 percent – believe it is safe to deliver before 38 weeks.

"While firm conclusions cannot be drawn, we suspect that in many cases these surgeries are performed for indications considered insufficient to warrant early delivery,” said Robert L. Goldenberg, M.D., professor of Obstetrics and Gynecology (OBGYN), director of research for the OBGYN department at Drexel University’s College of Medicine and chairman of UnitedHealthcare’s Women’s Health Scientific Advisory Board.

"A woman’s perception of gestational age that defines preterm and whether prematurity poses a health risk are likely to be important factors in the decision-making process. Therefore it is important that physicians talk to their patients about the optimal timing of delivery. Risks and benefits based on published data in the medical literature need to be a part of that discussion,” said Dr. Goldenberg.

"The results of this study underscore the importance of educating expectant mothers on the risks associated with elective deliveries prior to 39 weeks in order to reduce neonatal complications,” said Tina Groat, M.D., national medical director of Women’s Health for UnitedHealthcare. "We at UnitedHealthcare are doing our part to inform pregnant women, and we strongly encourage them to consult with their physicians about the risks associated with pre-term delivery.”

A nationwide study published in the January 2009 edition of the New England Journal of Medicine found that from 1999 to 2002, more than 35 percent of elective C-section deliveries were performed before 39 weeks’ gestation. This research revealed that babies born at 37 weeks’ gestation were twice as likely to have health problems, usually respiratory in nature, than babies born at 39 weeks or later. Neonatal intensive care unit (NICU) admissions were 5.9 percent at 39 weeks’ gestation, and rose to 8.1 percent at 38 weeks and 12.8 percent at 37 weeks.⁴

Further, a review of UnitedHealthcare data for mothers and their newborns showed that 48 percent of newborns admitted to the NICU were from scheduled admissions for delivery, and many were before 39 weeks’ gestation.

UnitedHealthcare is using the recent research study as part of a data-sharing campaign to educate health care providers, including physicians and hospitals, about the risks associated with scheduled procedures. This includes a page on UnitedHealthcare’s physician Web site, www.unitedhealthcareonline.com, where obstetricians can access tips on how to discuss optimal timing of delivery with their patients. UnitedHealthcare is also continuing to engage and empower women to make safer choices for themselves and their unborn babies during their pregnancies through its Healthy Pregnancy Program.

About UnitedHealthcare

UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of approximately 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.

1. Goldenberg, RL, McClure EM, Bhattacharya A, Groat TD, Stahl PJ. Women’s Perceptions Regarding the Safety of Births at Various Gestational Ages. Obstet Gynecol 2009;114:1254-8.
2. Tomashek, K., et al. Differences in Mortality Between Late-Preterm and Term Singleton Infants in the United States. Journal of Pediatrics, volume 15, November 2007, pages 450-456.
3. Petrini, J., et al. Increased Risk of Adverse Neurological Development for Late Preterm Infants. Journal of Pediatrics online, December 11, 2008.
4. Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. NEJM 2009;306:111-120.