Evidence is mounting that both mothers and newborns are at heightened risk of health problems following nonmedically necessary early-term deliveries. In response, hospitals nationwide are instituting policies to eliminate the procedure.
In late June, the American Hospital Association board of trustees issued a policy supporting those efforts.
Babies are considered full term between 37 and 41 weeks of gestation. Early-term deliveries occur during the first two weeks of this period. The number of elective early-term deliveries — either by induction or cesarean — nearly doubled to 22.5 percent in 2006, up from 9.5 percent in 1990, according to the most recent data available from the Centers for Disease Control and Prevention.
"Women who are induced in the 37th to 38th week have a significantly higher risk of having a cesarean section than mothers who have spontaneous labor," according to the Leapfrog Group. "And, given low rates of vaginal births after cesarean sections, these mothers are likely to have additional cesarean sections with increasing risks."
Citing other studies, the patient safety group goes on to note that babies induced during these early weeks are at higher risk of neonatal mortality and morbidity, including respiratory problems. Length of stay also typically increases for both moms and newborns, who are put in neonatal intensive care units.
To control inductions, Utah's Intermountain Healthcare educates doctors and patients. A team of nurses, physicians and administrators designed a data-rich program to explain the risks of the procedure, says Teri Kiehn, R.N., operations director of Intermoutain's women and newborns clinical programs.
"Our elective induction rate dropped from more than 30 percent to 2 percent," she says. "We've made significant inroads, and it's improving. We were at 1.2 percent, and we'd love to reach zero. It's a work in progress."
Physicians who ignore the policy meet with Intermountain's medical director to review existing best practices and clinical evidence. The goal, Kiehn says, is to reinforce that pre-determining times is risky.
Health officials in Minnesota targeted unnecessary inductions in 2009, according to Jeff Schiff, M.D., medical director, Minnesota Health Care Programs, Department of Human Services. The state has a multistep plan to identify necessary inductions, and 70 out of Minnesota's 90 hospitals participate.
Proposed inductions are reviewed to decide whether they're necessary. Providers and patients are informed and talk about the risks of an early-term delivery.
"It's important to stop thinking birth at 37 weeks is OK," Schiff says. "Our goal is getting people thinking more than 39 weeks."