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Hospitals Urged to Track Quality in Obstetrics

Cheryl Clark, for HealthLeaders Media, February 2, 2012

What better time to go public about healthcare quality than at the start of life?

That's what The Leapfrog Group is trying to do with an annual survey that reveals by name those hospitals with unacceptably high (more than 5%) rates of elective inductions and Cesarean sections performed "for no medical reason" between 37 and 39 weeks.

No reason, that is, except that it was more convenient for the obstetrician, for the hospital, or perhaps for the patient, and draws more revenue in fee-for-service payment systems. Rates of these elective early births, or "social" deliveries involving medical interventions, have skyrocketed over the last decade.

It's not just about the money, although childbirth mishaps linked to these early births add $1 billion to healthcare costs. Evidence has accumulated in the last two years about significant harm, including neurodevelopmental problems, rates of disability, brain size, and sleep behaviors, in babies born just a few weeks too soon.

Organizations tracking this trend attribute it to the fact that pregnant women haven't been informed about the terrible consequences associated with some elective inductions or C-sections performed before 40 weeks. If expectant mothers knew, they would certainly wait.

Now, data is accumulating to better document the harm obstetricians and hospitals can cause mothers and their babies when providers give assurances that a 37 to 39-week old fetus is good to go. A stay in an expensive NICU is not the same thing as longer gestation.

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