Rates of Early Elective Births 'Disturbing,' Says Watchdog Group

Cheryl Clark, January 28, 2011

Hospitals and their obstetricians must drastically reduce the number of pregnant women who – through pressure or lack of correct information – agree to undergo non-medically necessary labor induction before their 39th week because they are not safe.

That's the message from The Leapfrog Group, an employer-supported hospital quality watchdog group that receives voluntary information from some hospitals. In an effort to educate providers to change their practices, the group is making each facility's induction rates public for the first time to show the enormous variability and extent of potentially harmful early deliveries.

"This has been extremely disturbing (finding) to our members," Leapfrog CEO Leah Binder said in a news conference this week. "We are calling for hospitals to put policies in place that prevent (non-medically necessary) early elective delivery."

The group released its Call to Action: Protect Mothers and Babies from Unnecessary Harm" in conjunction with the March of Dimes  and its senior vice president and medical director, Alan R. Fleischman, MD, and the advocacy group, Childbirth Connection. The Call to Action was prepared in a partnership with several of the largest health plans, including CIGNA, UnitedHealthcare and WellPoint, in a plan to improve quality and lower costs.

The 773 hospitals in Leapfrog's 2010 hospital survey reported 57,000 early elective deliveries by Cesarean section or induction during the reporting period, with varying rates as high as 100-fold from hospital to hospital and state-by-state, Binder said. In at least one hospital, nine in 10 births were delivered with unnecessary early induction, the report shows.

For example, Riverside Community Hospital Riverside, CA reported a 55.1% rate of early induction, while the University of California Ronald Reagan Medical Center reported its rate at 4%. Putnam Hospital Center Carmel NY reported a 94.3% rate.

Hospitals should have rates of elective induction no higher than 5%, Binder says.

"Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varies among hospitals even in the same state or community," Binder said.

"We all know that there are clearly instances when an early delivery is medically necessary for the health of the mother or the baby," Fleishman said. But, as the American Congress of Obstetricians and Gynecologists makes clear in its guidelines, there should be no elective induction or scheduled Cesarean delivery before 39 weeks without clinical indication.

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