Rates of Early Elective Births 'Disturbing,' Says Watchdog Group
"Even a mature fetal lung test before 39 weeks in the absence of appropriate clinical circumstances is not an indication for delivery," Fleischman said. "Healthcare professionals and patients must continue to make those hard clinical choices while they remember that critical development occurs to a baby's brain, lungs, liver and other organs during the last weeks of pregnancy (and) one-third of fetal brain development occurs in the last five weeks of pregnancy.
"And there are significant increased problems for babies born just a few weeks early (such as) neonatal intensive care unit admissions, feeding problems, jaundice, inability to hold temperature, and tremendous increased costs. Every week counts."
Asked why medically unnecessary inductions are increasing, and why there is so much variability across the nation, Fleischman said that a "perfect storm" has increased the occurrence.
- First, often the mother is at the end of her pregnancy and feels that she's had enough.
- Second, the doctor wishes "for convenience to schedule his or her life...we have a much more interventionist practice these days....Obstetricians are in fact pretty anxious to deliver babies early."
- And third, women have misperceptions about the safety of earlier birth. According to a 2009 report, Fleischman said, one in four women believe that 34 to 36 weeks is full term and another 50% think 37-38 weeks is full term. "75% got it wrong. A true full term is 39-40 weeks and women think there are no medical complications for early delivery."
The Leapfrog report asked hospitals to submit the percentage of inductions and Cesarean sections between the 37th and the 39th week. These elective early procedures were classified as non-medically necessary if they were not done for any of the several dozen justifiable exclusions specified by the National Quality Forum, such as the women in labor had hypertension or diabetes or multiple gestation.
The Leapfrog Group suggests this web site as a resource for providers who want more information on guidance for the appropriateness of early induction procedures.
The site lists several reasons women are given for why they should have early induction that are not supported by rigorous research. Those reasons include:
- · Preterm pre-labor rupture of the membranes
- · Twin pregnancy
- · Gestational diabetes requiring insulin
- · Intrauterine growth restriction (IUGR) at term and
- · Oligohydramnios (too little amniotic fluid).
Asked why Leapfrog Group is targeting hospitals and not specifically physicians who perform the procedures, Binder replied that physicians are "key caregivers when these deliveries are scheduled to o early and obviously they have a critical role in that happening."
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