Rate of Babies Born Electively Before 39 Weeks Falls Dramatically
Washington State hospitals, physicians and expectant mothers have teamed up to deliver a dramatic increase in the number of babies born at full term – 39 weeks – instead of earlier in their pregnancies. They did this by rapidly changing established obstetric practices in place for many years. This change came about because of new research demonstrating the short and long term hazards of delivery prior to 39 weeks.
"Advances in medicine have created the expectation that babies born a little bit early will be fine. However, we have all been surprised by recent research showing increased complications and costs for babies born before 39 weeks. We now know that additional time in the mother's uterus provides benefits to a baby that can be objectively measured as long as five to ten years after birth," said Dr. Thomas Benedetti, Professor and Vice Chair of Obstetrics and Gynecology at the University of Washingtonand longtime member of the Washington State Perinatal Advisory Committee.
Last year, among babies born after 37 weeks and before 39 weeks, the proportion of babies born via induction or c-section with no medical reason plunged by 65 percent, from 15.3 percent in the third quarter of 2010 to 5.4 percent by the fourth quarter of 2011. This represents more than 650 fewer early elective deliveries statewide over a year. Data by hospital can be seen at wahospitalquality.org.
Hospitals have put a variety of policies in place to reduce the rate of early elective deliveries:
- Many require documentation of a medical reason every time a woman is scheduled to deliver before 39 weeks.
- Some hospitals will not schedule a delivery without the approval of the chief of obstetrics.
- Others are undertaking extensive physician and patient education about the risks of early elective deliveries.
"Babies need time to mature," said Dr. Jeff Thompson, Chief Medical Officer, Washington State Health Care Authority. "At 37 weeks, the brain weighs 20 percent less than at 40 weeks. Babies who are delivered early without a medical need are at risk, along with their families and the state. This program shows that we can work together to ensure better access to quality affordable health care."
"The end of a pregnancy can be tough physically and emotionally for some mothers. Because medical science advanced to help small babies survive, obstetric providers and mothers in the past would agree to deliver the baby two or three weeks early to relieve some of the physical and emotional discomforts of the last weeks of pregnancy," said Carol Wagner RN, Senior Vice President for Patient Safety at the Washington State Hospital Association. "But babies' lungs, liver, ears, and eyes need time to develop. At the end of pregnancy, babies add body fat so they can stay warm, and develop the skills to suck and swallow."
"We now understand that delivering a baby before 39 weeks gestation for non-medically necessary reasons is just not worth the risk to the future health of the baby and the health of the mom. The March of Dimes has created the 'Healthy Babies are Worth the Wait' health education campaign to educate providers and mothers about this important message," said Dave Brooks, Board Chair, March of Dimes and CEO, Providence Regional Medical Center Everett.
The effort to reduce early elective deliveries is a partnership between physicians, the Washington State Hospital Association, the Washington State Health Care Authority, the Washington State Department of Health, the March of Dimes, midwives, and regional perinatal coordinating nurses. It remains an ongoing focus for statewide quality improvement in obstetrics.
There are still many reasons for delivery of a baby prior to 39 weeks including conditions that threaten the well-being of the mother, the baby, or both. The decision to deliver a patient before 39 weeks needs to be made by collaboration between skilled obstetrical and newborn providers together with the knowledge and consent of the mother.