Doctors delivering babies early much less often, survey finds

02/21/2013 11:34 AM

02/22/2013 6:54 AM

Doctors have been warned for decades about the dangers of delivering babies early without medical reasons, but the practice remained stubbornly persistent.

Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to the latest hospital survey from The Leapfrog Group, a coalition of some of the nation’s largest corporations that buy health benefits for their employees.

The national average of elective early deliveries fell to 11.2 percent last year from 14 percent in 2011 and 17 percent in 2010. Nearly 800 U.S. hospitals report their data to Leapfrog, about a third of the American facilities that offer maternity services.

“This data shows more hospitals are responding to the evidence,” said Cindy Pellegrini, a senior vice president at the March of Dimes, which has been educating women and working with hospitals and doctors to lower early delivery rates. “This means babies are being born healthier and having a better start in life, and have a much greater likelihood of avoiding health consequences later on in life.”

Babies born before 39 weeks are more likely to have feeding and breathing problems and infections that may result in admissions to neonatal intensive-care units than those who are born later, studies show. The elective deliveries may cause developmental problems that show up years after birth.

Inducing labor early also carries risks for mothers because it increases the chances they’ll need cesarean sections.

Since 1979, the American College of Obstetricians and Gynecologists has recommended against deliveries or induced labor before 39 weeks unless there’s a medical indication, such as the mother’s high blood pressure or diabetes or signs that the fetus may be in distress.

Still, an estimated 10 to 15 percent of U.S. babies continued to be delivered early without medical cause, according to a report last year by the Department of Health and Human Services.

Leapfrog Chief Executive Officer Leah Binder said she was encouraged by the latest figures but that the rates were still too high at many hospitals, as high as 40 percent in some. “This is a move in right direction, but more needs to be done,” she said.

Leapfrog wants to see rates no higher than 5 percent, a target achieved last year by nearly half of the reporting hospitals, up from 39 percent of hospitals in 2011.

State averages varied from a high of 26 percent in Pennsylvania to a low of 5.9 percent in Massachusetts and New York. Only states with at least 10 hospitals reporting data were counted toward state averages.

One reason some hospitals have been slow to lower their rates is a reluctance to pressure doctors to change their practice, Binder said.

Some rural hospitals may have higher rates because doctors in solo practices sometimes deliver babies early to stagger their workloads. Women who are unaware of the higher risks also may ask to deliver early out of convenience.

Some of the most dramatic improvements last year came from states such as South Carolina and Illinois, where business groups and insurers have exerted pressure to decrease high-risk deliveries. In Illinois, the rate has been cut almost in half, to about 7 percent, through efforts by organizations such as the Midwest Business Group on Health.

Employers and insurers have gotten involved partly to reduce health costs, since stays in neonatal intensive-care units can average well over $60,000.

This year, the South Carolina Medicaid program and BlueCross BlueShield of South Carolina stopped reimbursing providers for performing early deliveries without medical causes. The state, working with the March of Dimes and other groups, asked hospitals last year to reduce their rates of early deliveries voluntarily. The rate of early elective deliveries in South Carolina hospitals fell to 10 percent last year from 19 percent in 2011, the Leapfrog data show.

“We are pleased to see these improved health outcomes,” said Kim Cox, a spokeswoman for the South Carolina Department of Health and Human Services.

Texas Medicaid stopped paying for early elective deliveries in 2011, and New York and New Mexico are considering similar actions, according to state officials.

Some hospitals are moving on their own. Boston Medical Center reduced its rate to 5.3 percent last year from 22.5 percent in 2011 by reminding doctors that delivering babies even one or two days before 39 weeks wouldn’t be allowed without medical cause. The hospital informed women about the policy during prenatal care.

“All of the nurses, midwives and doctors on labor and delivery are aware that decreasing elective deliveries prior to 39 weeks is an important goal for our service,” said Dr. Ronald Iverson, the director of quality improvement for obstetrics and gynecology at Boston Medical Center.

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