Posted: 5:39 p.m. Monday, April 8, 2013
By Phil Galewitz
When hospitals commit to stopping the delivery of babies before 39 weeks gestation unless there is medical cause to do so, they can dramatically lower rates that can put babies at increased risk for serious health problems.
A study published Monday in the journal Obstetrics & Gynecology showed a group of 25 hospitals in five states were able to cut rate their rates of elective early deliveries from nearly 28 percent to under 5 percent in one year. The March of Dimes, which partly funded the study and assisted the hospitals in setting up new policies and procedures, said the findings show hospitals can overcome cultural and economic barriers to lower their rates.
“We are really moving the goal line for hospitals and doctors who may have thought delivering a baby at 37 weeks was going to be fine,” said Dr. Edward R.B. McCabe, medical director of the March of Dimes. “We have learned in recent years that babies born at 37 and 38 weeks are at higher risk of death and other problems.”
The American College of Obstetrics & Gynecology has recommended for nearly three decades that doctors and hospitals wait until at least 39 weeks to perform elective inductions or Cesarean sections. But rates have remained stubbornly high because either women did not know about the risk or doctors delivered babies early as a convenience to themselves or their patients. An estimated 10 to 15 percent of U.S. babies every year are delivered early without medical cause, according to the Department of Health and Human Services. Babies born before 39 weeks are more likely to have feeding, breathing and developmental problems than those born at 39 or 40 weeks.
The developmental problems are often longterm.
In a study in the April 2013 edition of Pediatrics, Emory University researchers found that babies born before 38 weeks had lower scores on standardized tests in first grade. The findings suggested that birth history plays an important role in cognitive development.
Those kind of long-range ramifications may have not been obvious to doctors and hospitals in the past. But McCabe said growing numbers of hospitals are enacting policies after being shown research on the increased risks early delivery poses for the baby, he said.
“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” said Dr. Bryan T. Oshiro, an obstetrician from Loma Linda University School of Medicine and lead author of the study.
The hospitals that took part in the five-state study were:
California: El Centro Regional Medical Center, Mission Hospital, Mills-Peninsula Health Services, Sutter Roseville Medical Center, Sutter Medical Center Sacramento, San Gorgonio Memorial Hospital;
Florida: Broward General Medical Center, Lee Memorial Health System, Plantation General Hospital, Santa Rosa Medical Center, South Miami Hospital, St. Joseph’s Women’s Hospital;
Illinois: Decatur Memorial Hospital, Edward Hospital, Katherine Shaw Bethea Hospital, St. Elizabeth Hospital, St. Joseph Hospital, University of Illinois Hospital and Health Sciences Systems;
New York: Clayton-Hepburn Medical Center, Stony Brook University Medical Center;
Texas: Baylor University Medical Center, Medical Center Hospital, Scott & White Memorial Hospital, St. Joseph Medical Center, University Medical Center of El Paso.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.