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High Rates of Early Elective Delivery at Some U.S. Hospitals: Report
Date:1/26/2011

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Jan. 26 (HealthDay News) -- Five to 40 percent or more of births in the United States are induced early without any good medical reason, according to a new hospital-by-hospital report.

And there is tremendous variation in the rates documented by hospitals voluntarily reporting these "early elective induction" deliveries, even within the same community. In Los Angeles, for instance, the rates of babies delivered early without a good medical reason ranged from 4 percent to 29 percent. In Boston, the rates reported by different hospitals ranged from near zero to 27 percent.

"This is the first real evidence that the practice of scheduling newborn deliveries without medical reasons is common and varies among hospitals," said Leah Binder, CEO of Leapfrog Group, an employer-driven hospital quality watchdog group. Leapfrog announced the findings of its annual hospital report at a Wednesday news conference.

"The information is extremely disturbing," she continued. "We are calling on hospitals to put policies in place to prevent early elective deliveries."

According to Binder, "elective inductions have now outpaced medical inductions."

The consequences of such deliveries can be grave. "The last few weeks of a pregnancy are critical to the development of the baby's brain, lung and liver," said Dr. Alan Fleishman, senior vice president and medical director of the March of Dimes Foundation. "Babies born just a few weeks early have feeding problems, jaundice, inability to hold temperature and tremendous increased costs. Every week counts."

Babies delivered early also face a higher risk of death, spending time in a neonatal intensive care unit and life-long health problems, according to a statement from the Leapfrog Group.

Plus, using gestational dating to figure out a delivery time can be "grossly inadequate" unless a woman has an ultrasound exam in the first trimester, Fleishman pointed out. If the dating is off by even two weeks, the baby could end up being premature (born before 37 weeks), he said.

Leapfrog's target goal for 2010 was 12 percent, but it is now lowering that threshold to 5 percent, said Barbara Rudolph, senior scientific director of Childbirth Connection, an advocacy group that promotes quality maternal care.

The good news is that about 50 percent of hospitals reported early elective delivery rates of 12 percent or below. The bad news is that an equal half reported rates higher than that figure.

But more good news is that 29 percent of hospitals reported rates of 5 percent or less, indicating that such low rates are achievable, said Rudolph.

Why are so many early elective deliveries occurring?

According to Maureen Corry, Childbirth Connection's executive director, a recent survey found that the leading reason (accounting for about 25 percent of early births) was caregiver concern that the mother was overdue. About 19 percent were medical inductions, another 19 percent were due to the mother's desire "to get the pregnancy over with," and the final one (17 percent) came from concern about the size of the baby. According to Fleischman, large babies aren't a valid reason for early delivery.

And 75 percent of mothers actually think that 34 to 36 weeks is full-term (although it is really 39 to 40 weeks), Fleischman added. Providers' desire for convenience and predictable schedules could also play a role.

"We encourage women to wait until they've completed the 39th week of pregnancy [to deliver] unless it's medically called for," Binder said. "Every woman in America needs to know [information on a hospital's early elective delivery rate] before she enters the door of a hospital."

More Information

Leapfrog has national hospital-by-hospital data on early elective deliveries.

SOURCES: Jan. 26, 2011 teleconference with Leah Binder, CEO, Leapfrog Group, Washington, D.C.; Alan R. Fleischman, M.D., senior vice president and medical director, March of Dimes, White Plains, N.Y.; Barbara Rudolph, Ph.D., senior scientific director, Childbirth Connection; and Maureen Corry, executive director, Childbirth Connection, New York City


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