Effort to stem early deliveries pays off

Health officials and leaders say they've seen a steep, recent drop in the number of babies delivered before 39 weeks.

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Moms-to-be and their physicians have long worked to deliver the healthiest babies possible. Now studies show there's one more step to giving an infant the best shot at short-term and lifetime good health.

Babies who are delivered before 39 gestational weeks can encounter a multitude of problems, a panel of experts warned in a press conference this week. Leaving a baby in the womb until then - whenever medically possible - is the new goal, they said.

A collaborative effort in Washington is working at reducing the number of all "early elective deliveries," defined as births where moms and health-care providers, not nature, decide the due date.

Since its inception 12 months ago, the campaign by the Washington State Hospital Association, the state Legislature and March of Dimes has resulted in a 65 percent drop in such deliveries, equaling 656 fewer elective deliveries so far. Washington hospitals have decreased the statewide average from 15.3 percent in the third quarter of 2010 to 5.4 percent in the fourth quarter of 2011.

The movement is a shift away from a long-standing medical practice of delivering babies for convenience and other non-emergency reasons, said Dr. Thomas Benedetti of the University of Washington's department of obstetrics and gynecology.

Delivering a baby before the mother reached full-term gestation became viable once medicine was able to better save pre-term infants. So much so that 37 weeks became considered full-term. The rate of such births had climbed for a number of reasons.

"The end of a pregnancy can be very tough for mothers," said panel member Carol Wagner, a registered nurse and vice president for patient safety with Washington State Hospital Association.

"Advances in medicine have created the expectation that babies born a little bit early will be fine," the group said in a news release. There will always be medically-necessary pre-term deliveries but science has shown babies born before 39 weeks can suffer a number of health consequences.

Babies born before full term are more likely to require Caesarean section deliveries, need neonatal intensive care, have higher rates of infection and incidences of hospitalizations. They also face increased risk of newborn death.

Infants born at 39 weeks or more have bigger brains, are able to feed better, are physically stronger and have better-tuned reflexes that allow them to interact better with their parents, said Dr. Jeff Thompson, chief medical officer for Washington state Health Care Authority.

At an older age, these children even read and spell more proficiently, he noted.

Full-term infants are also more equipped to fight infection, he said, adding there is whooping cough epidemic in Washington state at the moment.

Even with the state's current "great" birth outcomes, the March of Dimes slogan has it right, Thompson said. "‘It's worth the wait' … When we wait until the baby is ready to come out and join the world, we find that their bodies are ready to take on the hazards of the real world."

For the first time, hospital-specific "early elective delivery" data was made public in Washington state at the joint press conference. Hospitals are key in the campaign to reduce elective deliveries, panelists noted. With standard policies across the board, patients can't "doctor shop" for a provider who will agree to deliver early for non-medical reasons. And physicians won't "hospital shop" to accommodate those requests.

Hospitals are in an advantageous position to set the boundaries, even if it means involving chiefs of obstetrics and simply saying "no" to early elective births, health professionals said.

To motivate hospitals, the collaborators set an ambitious but achievable benchmark, a goal that required hard work but one that all facilities could achieve, the panelists said. The measure was one of five, part of a $10 million health campaign - the money was set aside in the 2010 state budget - that included a focus on immunizations and unnecessary emergency room visits. Modest amounts of money were used to reward hospitals for good performances. "A much more powerful incentive … that got the attention of communities," explained panelist Sen. Karen Keiser, D-Kent, chair of the Senate Health and Long Term Care committee.

In Walla Walla, Providence St. Mary Medical Center and Walla Walla General Hospital had zero elective early deliveries during the past year. In the Tri-Cities, where some local mothers deliver babies, Kadlec Medical Center had a rate of 17.4 percent and Kennewick General had a 14.2 percent rate in the same time frame.

The quick drop in rates statewide is phenomenal, the panel agreed. "The results defy usual evidence," Keiser said. "It usually takes about 15 years to change a medical practice. This time it took 12 months, an amazingly short time."

It's not about spending or saving money, Thompson pointed out. Nonetheless, "healthier kids are less expensive kids."

Benedetti found that by talking to women considering early delivery, most decline the option upon hearing possible consequences for their babies, he said. "And if someone insists, you just say ‘No, I won't do that.'"

Many women are just learning this information, added Cassie Sauer with Washington State Hospital Association.

It's important to realize that there will always be valid reasons for some women, such as high blood pressure, to give birth earlier than 39 weeks and any woman in those circumstances should allow for medical intervention, Benedetti cautioned. "There are some gray areas. The number (of early births) should not be zero. Too low runs the risk of unexpected still birth."

For more information go to www.wahospitalquality.org.

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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