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Hospitals Enact Policies to Curb Early Childbirth

Goal is to reduce elective C-sections, inductions before 39 weeks, study says
MONDAY, May 6, 2013 (HealthDay News) -- Hoping to curb elective Cesarean births and labor inductions, two-thirds of U.S. hospitals have implemented policies to eliminate medically unnecessary pre-term births, a new study reports.
Pre-term deliveries (before 39 weeks' gestation) carry an increased risk of neonatal respiratory distress and admission to neonatal intensive care units (NICU), researchers from the University of Pennsylvania Perelman School of Medicine said.
For the study, the researchers questioned nearly 2,400 hospitals about their policies on early deliveries that weren't necessary for medical reasons.
They found that 66.5 percent of the hospitals had a formal policy against the practice, and more than two-thirds of these hospitals had a "hard-stop" policy, or a strictly enforced rule, against elective deliveries before 39 weeks of gestation.
"There is reason to be encouraged that hospital policies are decreasing the frequency of this practice, and we expect that fewer elective deliveries prior to 39 weeks means fewer term babies going to the NICU," study leader Dr. Nathaniel DeNicola said in a news release from the American College of Obstetricians and Gynecologists.
Another one-third of hospitals had no policy on such deliveries, but 53 percent of those hospitals said medically unnecessary deliveries before 39 weeks were against their standard of care.
State initiatives to help inform the public about the risks associated with elective early deliveries have been effective in encouraging hospitals to adopt formal policies against these pre-term deliveries, the study authors added.
"We had a number of hospitals volunteer that they were following the state initiative," DeNicola said.
The findings are scheduled for presentation Monday at the annual clinical meeting of the American College of Obstetricians and Gynecologists in New Orleans.
A separate study conducted by researchers from Baystate Medical Center in Springfield, Mass., showed that by restricting elective deliveries, hospitals can reduce the number of Cesarean births. These policies also can cut the amount of time between when a woman is admitted to the hospital and when she delivers her baby.
"What we used to see here were some providers performing elective inductions in patients, many of whom were fewer than 39 weeks of gestation, with unfavorable cervices," said study leader Dr. Andrew Healy. These inductions could take two or three days, and often ended in a Cesarean delivery, he said.
"We don't see that anymore since implementing a policy restricting elective labor induction, which is terrific," he said. "The mothers are more likely to be able to take their baby home with them and, having had a vaginal birth, are less uncomfortable and better able to care for their child."
For this study, which also will be presented at the American College of Obstetricians and Gynecologists meeting, Healy's team analyzed records of more than 9,500 single births at Baystate before it implemented a policy that set restrictions on labor inductions. The researchers also examined more than 2,600 single births that occurred after the policy was established.
Specifically, the researchers considered time from admission to delivery, Cesarean rates, NICU admission rates and stillbirths.
Average time from hospital admission to delivery for elective inductions decreased by six hours -- from 17 hours to 11 -- after the policy was implemented, the study found. The Cesarean delivery rate for women who underwent elective inductions dropped from 16 percent to 7 percent after the policy was put into place, and the policy resulted in a 33 percent reduction in the admission of term babies to the NICU.
Data and conclusions presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
More information
The Agency for Healthcare Research and Quality provides more information on elective induction of labor (http://www.effectivehealthcare.ahrq.gov/ehc/products/135/354/induction%20of%20labor%20clinician%20guide.pdf ).
SOURCE: American College of Obstetricians and Gynecologists, news release, May 6, 2013
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