Effort to reduce early deliveries paying off

State campaign to cut elective births benefits babies, officials say

By Marissa Harshman, Columbian Health Reporter



More Washington babies are staying in utero longer thanks to a statewide push to reduce the number of elective deliveries.

For years, physicians considered women who are 37 to 39 weeks’ pregnant to be full term. New research, however, has shown delivering babies prior to 39 weeks’ gestation for non-medical reasons can have short-term and long-term effects, said Dr. Thomas Benedetti, professor of obstetrics and gynecology at the University of Washington.

The research surprised the medical field and prompted hospitals, physicians and various organizations across the state to join forces to spread the message, “Healthy babies are worth the wait.”

“We thought everything was safe,” said Jeff Thompson, chief medical officer for the Washington State Health Care Authority. “We recognize that the March of Dimes had it right. It’s worth the wait.”

In 2010, the state Legislature created an initiative encouraging physicians and families to wait to deliver babies and offered incentives to participating hospitals, said Sen. Karen Keiser, D-Kent.

In just 12 months, the state was able to transform standard medical practices and drastically reduce the number of elective deliveries prior to 39 weeks, Keiser said.

Statewide, the number of babies delivered electively at 37 to 39 weeks’ gestation plunged 65 percent from the third quarter of 2010 to the fourth quarter of 2011. In 2010, about 15 percent of early births across the state were elective deliveries. In 2011, the percentage dropped to 5.4 percent.

In Clark County, about 30 percent of early deliveries at Legacy Salmon Creek Medical Center were elective. A year later, the percentage dropped to below 5 percent. The first quarter of this year, less than 2 percent of early deliveries were elective, said Rhonda Linn, manager of the Family Birth Center.

At PeaceHealth Southwest Medical Center, about 7 percent of early deliveries were elective during the second half of 2011, according to state data. Baseline data for the hospital wasn’t available.

Prior to the initiative, physicians would allow women to schedule deliveries as long as they reached the 37-week mark. The reasons for elective deliveries ranged from women being physically uncomfortable to wanting the birth to coincide with spouse time off work, Benedetti said.

“We’re now learning that probably isn’t a good enough reason,” he said.

Those who need to deliver early due to medical risks for the woman or baby will still be induced prior to 39 weeks, if necessary. And women who go into labor on their own before 39 weeks shouldn’t worry about possible negative effects, Benedetti said.

Waiting until babies reach 39 weeks brings health benefits, according to health officials.

During the last few weeks of pregnancy, babies’ bodies and organs are still developing. Earlier deliveries can result in lungs that aren’t fully developed, which leads to babies in neonatal intensive care on ventilators, the state’s Thompson said.

In the final weeks, babies are also learning to suck, which affects feeding. In addition, higher premature delivery rates translate to higher caesarean section rates, Thompson said.

Early deliveries can have long-term effects as well, Benedetti said.

Research has shown that babies born at 37 to 38 weeks’ gestation compared to 39 weeks have higher incidences of multiple hospital admissions, long-standing illnesses that limit activity and measurable differences in reading and spelling, Benedetti said.

The efforts are also making an impact locally.

Legacy has seen a decrease in the number of admissions to the neonatal intensive care unit and a drop in C-section rates since implementing the policy, Linn said.

The hospital has also seen an increase in the number of women coming in with spontaneous labor, she said.

“I think it’s been a very successful campaign, and it was the right thing to do,” Linn said. “It benefits our tiniest citizens.”

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; marissa.harshman@columbian.com.