To discourage planned early deliveries, hospitals are banning moms from scheduling births before 39 weeks without a medical reason. And it’s working.
Several years ago when Dr. Scott Berns spoke with colleagues about slashing rates of early elective deliveries at their hospitals, he met with considerable indifference.
“They’d say, This is not a problem for me,” says Berns, deputy medical director at the March of Dimes, which helped develop a “toolkit” for hospitals committed to discouraging women with healthy pregnancies from giving birth before 39 weeks. “And I’d say, Look at your data.”
Ultimately, 25 hospitals in the five states that account for 38% of U.S. births agreed to participate in a study to gauge the effectiveness of the toolkit in steering women and their doctors away from scheduling early inductions or C-sections for otherwise healthy pregnancies. The hospitals succeeded in cutting the rate of early elective deliveries by 83%. Researchers have now set their sights on 100 more hospitals around the country, hoping to reverse the trend toward scheduling elective delivery as early as 37 weeks into a pregnancy.
In some ways, women’s desire to deliver at 37 weeks is understandable, since many pregnancy guides and professional organizations define 37 weeks as “full term,” leading women to believe they can deliver safely any time after that. Babies delivered before 37 weeks are considered premature and can have trouble breathing, but doctors are increasingly aware that even at 37 weeks, babies aren’t done developing in utero. Early-term babies, born between 37 weeks and 39 weeks, are at higher risk for infections and are more likely to be hospitalized in a neonatal intensive care unit, and studies show that these babies have twice the infant mortality rate as those born after 39 weeks.
Berns and his colleagues conducted the research, which was published in the journal Obstetrics and Gynecology, to see if a concerted effort to reduce early-term elective delivery could turn the tide. They relied on birth data collected in 2011 from 25 hospitals in New York, Florida, Illinois, Texas and California that agreed to ban delivery before 39 weeks unless it was medically necessary.
With the new policies in place, the hospitals reduced elective early term deliveries from 28% in January 2011 to less than 5% in December 2011. “That’s a relatively short period of time to show significant change,” says Berns, the study’s senior author. “It’s really cool because we were able to show we could do this across a diverse set of hospitals in multiple states.”
As part of the toolkit, doctors and nurses learned about the latest statistics on the risks of early-term births, as well as the intricacies of fetal development. The program offered advice on implementing bans on early elective deliveries and provided forms to help doctors determine when a scheduled delivery might be warranted before 39 weeks. The toolkit was created by the March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health.
The doctors and nurses at the various hospitals also participated in regular phone calls to troubleshoot problems and share strategies. Some hospitals encountered physicians — and moms-to-be — who resisted the new policies. Doctors may prefer the ease of scheduling deliveries in certain situations to accommodate mothers who are tired of being pregnant. The best strategy for these situations? Education.
“If you show a mom that these last weeks of pregnancy really count, that the chances for a baby to be born healthy are higher if she waits it out a couple more weeks, that really resonates,” says Berns.
The study results bolster the message conveyed by a March of Dimes public-awareness campaign, Healthy Babies Are Worth the Wait, launched in 2011 and “Strong Start,” a national initiative that promotes full-term pregnancy to at least 39 weeks. Mothers can also take advantage of an app, CineMama, that subtly encourages pregnant women to hang in there by helping them to create a time-lapse video of their pregnancy.
In 2011, I wrote about a related pilot project that involved the five states in the study. To drive home the need for moms to be patient, Eugene Toy, academic chief of Obstetrics/Gynecology at St. Joseph Medical Center in Texas, compared gestation to baking.
“Most pregnant women when given a choice usually schedule their delivery date based on convenience,” says Toy. “Sometimes it’s even numerology. One patient chose her delivery date based on an astrological sign.
“I tell patients it’s like baking a cake,” says Toy. “Even if you have hungry guests, you don’t rush the cake out of the oven before it’s ready.”
In birth — just like in baking — timing is everything.