Rate of Early Deliveries Drops

Last week we blogged about the growing awareness of the wisdom of letting pregnant women take their time in labor, instead of rushing them into a cesarean section. This week, there’s more good news on the child delivery front: Hospitals are cutting down on early deliveries.

As reported in the Los Angeles Times, pressure from employers, government officials and patient-safety advocates has prompted hospitals to dissuade women from choosing to deliver early, in favor of waiting for nature to take its course. Last year, deliveries before 39 weeks without a medical reason numbered about 4.6 in 100; in 2010, the ratio was 17 in 100.

The survey of nearly 1,000 U.S. hospitals was sponsored by The Leapfrog Group, a nonprofit organization of businesses that promotes high-quality, cost-effective health care that we’ve mentioned before, primarily in blogs about hospital ratings.

Delivering a child early when there’s no medical reason to do so is a bad idea for several reasons. Potential complications for the baby include breathing and feeding problems, and infections. According to The Times, the rate of infant mortality in the first year increases by half for such early births compared with full-term babies.

Many parents, as we noted last week, schedule delivery for their convenience, which raises the probability of a cesarean section. Like all surgeries, C-sections present the risk of complications, in this case for the mother. And they’re expensive – it’s estimated that unnecessary early C-sections increase health-care costs by as much as $1 billion every year.

Leapfrog would like to see a hospital’s ratio of early deliveries at around 5 in 100; about 1 in 3 of the hospitals in its survey were above that, some by a significant margin. (Link to the Leapfrog report here to see how your hospital delivered the delivery numbers.)

But the overall result is one of what seems like few positive developments recently in health care. As The Times wrote, “[T]he swift improvement overall stands out compared to efforts to fix other long-standing quality and cost problems inside hospitals. Despite public attention and industry efforts, the incidence of medical errors, preventable infections and readmissions often remains stubbornly high.”

Leapfrog was instrumental, it seems, in prompting the change. It began publicly reporting maternity data several years ago, and now, under the patient safety promise of the Affordable Care Act (“Obamacare”), such data is being collected from hospitals nationwide.

The scrutiny, says The Times, has prompted many hospitals to adopt “hard-stop” policies that prohibit doctors from scheduling deliveries earlier than 39 weeks if there is no medical reason.

Health insurers, of course, are also players here, because it hits them in the wallet. Some insurance plans and government health programs won’t pay for early-elective deliveries.

And money is the reason why some hospitals are reluctant to adopt the best practice of full-term delivery: Leah Binder, chief executive of the nonprofit Leapfrog, said some hospitals are slow responders because admissions to the neonatal-intensive-care unit (NICU) and longer stays there boost the bottom line. (You can view data on individual hospitals on the Leapfrog website.)

The medical science is indisputable, but the cultural response lags. The Times interviewed Dr. Parissa Moradi, an ob-gyn at a Los Angeles ambulatory care center, who said that as many as 1 in 5 of her expectant mothers ask for early “social” deliveries.

“It’s mostly because they get tired of being pregnant,” Moradi told the paper. “I personally don’t like to do social deliveries before full term. I tell them all the risks involved and they can go somewhere else.”

Dignity Health, a large national hospital chain, adopted a “hard-stop” policy in 2012. Its rate of early-elective deliveries went from 7 in 100 in 2011 to less than 1 in 100 the next year. Dr. Robert Wiebe, Dignity’s chief medical officer, told The Times that because obstetricians usually aren’t involved in newborn care, many “don’t always know the consequences of early-elective delivery or they underestimate the risk.”

That seems a bit too compartmentalized, at best, and disingenuous at worst.

But Wiebe did say that sometimes doctors could be as much a part of the early-delivery problem as patients. He said it had been common for some to move up delivery dates to accommodate their travel schedules. And that their patients would be OK with that because they had developed a strong bond with that doctor.

“They are all seemingly legitimate reasons on the surface,” Wiebe told The Times, “but if you understand the risk to the baby it’s not the right thing to do.”

No, it’s not. And it’s deeply gratifying to know that more and more people understand that.

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