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Too soon for baby: Hospitals work to reduce early elective births


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Dr. David Szentes, obstetrician-gynecologist for Community Physician Network, examines Nineveh resident Kylie Browning during a regular checkup. Browning is 30 weeks pregnant. Part of the strategy for hospitals, including Community Health Network, to decrease early elective deliveries is regular education by their physicians as women get closer to their due date. Physicians are aiming to avoid any deliveries done before 39 weeks, unless for a medical reason.
PHOTO BY RYAN TRARES
Dr. David Szentes, obstetrician-gynecologist for Community Physician Network, examines Nineveh resident Kylie Browning during a regular checkup. Browning is 30 weeks pregnant. Part of the strategy for hospitals, including Community Health Network, to decrease early elective deliveries is regular education by their physicians as women get closer to their due date. Physicians are aiming to avoid any deliveries done before 39 weeks, unless for a medical reason. PHOTO BY RYAN TRARES


One of the great surprises of giving birth used to be guessing when the baby would be delivered.

Though women were given a due date when to expect their child to enter the world, delivery cannot be exactly predicted. Parents were left to wonder when.

But as medical technology has advanced, more women are opting to take the guesswork out of delivery. An increasing number of patients are asking their obstetricians to induce birth or schedule caesarean sections in advance of their due dates.

Instead of being done for medical reasons, the requests are made in the name of convenience. But research has shown that babies born earlier than 39 weeks experience a wide range of health problems, from underdeveloped lungs to inability to swallow.

FACTS ABOUT EARLY DELIVERY

Babies born early:

Have more learning and behavioral problems in childhood than those born at 39 weeks.

Are more likely to have feeding problems because they can’t coordinate sucking, swallowing and breathing as well as full-term babies.

Are likely to have breathing problems, such as apnea.

Are more likely to die of sudden infant death syndrome, when a baby dies suddenly and unexpectedly, often during sleep.

SOURCE: March of Dimes

Health officials throughout Johnson County have joined a national campaign to greatly reduce the number of these early elective deliveries. Starting with doctors and filtering down to the general public, officials are stressing the need to prevent these type of elective births in order to have healthier babies.

“It’ll be better for everybody if we would wait to at least 39 weeks. We’ll get better kids,” said Dr. Thomas Ferrara, a gynecologist for Community Physician Network. “That’s what is best for our patients; and if we’re not putting them first, we’re not doing them any benefits.”

Nationwide, the number of early elective surgeries has risen to an all-time high. According to the National Center for Health Statistics, induced labor had been used in 23 percent of all births in 2006, compared to 9 percent in 1990.

In 2009, caesarean sections accounted for 32 percent of all births, an all-time high.

“Looking at the history of births, it had always been considered 40 weeks before the baby was full-term,” said Minjoo Morlan, the program director for the March of Dimes Indiana chapter. “In less than 20 years, it has moved further and further up and become the new normal. But even one or two weeks is critical to a baby’s health.”

In a study of deliveries done at 27 hospitals throughout the country by the Hospital Corporation of America, 31 percent of deliveries were elective.

Part of that has been driven by patients who want the freedom to decide the best time to deliver their own children, Ferrara said. Planning delivery around a time when family and friends can be present or when weather appears to be the best is reassuring to parents.

In addition, many women experience the fatigue of carrying a child for 40 weeks. If they’ve delivered children earlier in the past, they might be more likely to delivery early this time around, Ferrara said.

Some doctors also prefer to control when and where a baby is born.

“You develop a connection with your patients. Maybe you’ve been with them through some difficult parts of the pregnancy. If I’m the one inducing the patient, then I know I’m the one there delivering it,” Ferrara said.

But that can have adverse affects on the baby.

Results show that babies delivered by choice earlier than 39 weeks were more than two times as likely to be admitted to a neonatal intensive care unit than those born after that benchmark. The mortality rate doubled.

Babies were more likely to experience newborn sepsis. They also have a tendency to go back to the hospital for emergency care or respiratory emergency.

“If a woman is having a baby earlier than 39 weeks without any medical indication that it’s necessary, there is that tendency for those babies’ lungs and brains to not be fully developed,” Morlan said.

The lungs are one of the last organs to develop in a baby, so early delivery affects that part of the body more than others. The brain also needs to be developed fully in order to command the body to breath correctly.

“The comparison between 39 or 40 weeks, or 35 weeks, the development of the brain is so different. It may only be a few weeks, but it makes a large difference,” Morlan said.

Franciscan St. Francis Health started addressing the issue of early elective delivery in 2009.

A policy requiring every early elective delivery to be reviewed by a physician was put into place. A hard stop policy, which prohibits early elective delivery without a medical reason, has drastically reduced the numbers, said Angela Bratina, registered nurse for Franciscan St. Francis Health.

Last year, Franciscan St. Francis Health had a drop in elective deliveries, from 18 percent of all births in December 2011 to 3 percent in September 2012.

“We’re trying to make sure our education is not just aimed at the medical profession, but that the general public knows as well,” Bratina said.

The issue has captured the attention of the March of Dimes, a nonprofit organization dedicated to helping women have full-term pregnancies and delivering healthy babies.

The March of Dimes has started a nationwide campaign called “Healthy Babies are Worth the Wait.” Teaming up with the U.S. Department of Health and Human Services, the group has unveiled a campaign of public service announcements, radio and television ads and educational pamphlets to go in doctors’ offices.

Organizers also have worked directly with hospital officials to stress how important this issue is. Their goal is to stop doctors from offering these early elective deliveries as options at all, said Tim Arndt, spokesman for the March of Dimes Indiana.

“The March of Dimes is not trying to get between a patient and their doctor,” he said. “The point is to ensure that when a baby is born too soon, it’s only done for a medical reason and not for any other reason.”

At Johnson Memorial Hospital, officials had set a goal of reducing early elective deliveries to fewer than 3 percent of all deliveries by the end of this year.

The strategy was focused on educating doctors and staff about early elective deliveries, said Michelle Bisesi, director of the hospital’s maternity services. Classes presented the dangers of early birth and how to address patients that request it.

Hospital officials also are working to implement a policy that would prevent doctors from performing these early elective deliveries unless there is a medical reason, Bisesi said.

In the first year of the campaign, the results show a decreasing number of early elective deliveries. From a high point of 17 such deliveries in April, the hospital recorded zero from August on.

During the past two or three years, Community Health Network has been working with doctors and patients to make the dangers of early elective delivery known.

By analyzing records and making phone calls to all of the network’s obstetricians, officials were able to reduce the number of early elective deliveries from 12 percent of all births to 4 percent, Ferrara said.

The health group is in the process of putting a hard stop to all early elective deliveries. Even those with medical reasoning behind them would be reviewed by a physician before being approved.

“There are tough calls out there that someone needs to make, and it’s the physician’s job to do that,” Ferrara said.

Officials are confident that as awareness of the problem becomes greater, the practice of early elective deliveries will drop to zero, Morlan said.

“It’s a matter of educating the public, so that women do not request these early deliveries,” she said.

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