Early Elective Deliveries Fall at Surveyed Hospitals

January 26, 2012

January 26, 2012 — The rate of early elective newborn deliveries — those before 39 completed weeks that are not medically indicated — declined on average from 17% in 2010 to 14% in 2011 among hospitals surveyed by the Leapfrog Group, a quality-improvement organization.

Furthermore, 39% of reporting hospitals in 2011 kept the rate of these problematic deliveries at or below 5% — a target set by Leapfrog — compared with 30% in 2010, according to survey findings released today.

The survey, however, turned up wide variation, with the rate of early elective deliveries at some hospitals topping 40%. And most reporting hospitals still fell short of the 5% target. Accordingly, Leapfrog said that more work needs to be done.

Leapfrog is a coalition of public and private purchasers of health insurance benefits that seeks to improve the quality of care while lowering the cost of care. Its members include large employers such as General Motors and FedEx and regional employer alliances.

The American Congress of Obstetricians and Gynecologists and other authorities caution pregnant women and their physicians against delivery by induced labor or cesarean delivery before the 39th completed week unless a condition such as maternal high blood pressure or pre-labor membrane rupture occurs. Babies need those last few weeks for their brains and lungs to fully develop. Delivering a baby before the 39th week can lead to short-term morbidities such as respiratory distress, temperature instability, and infection, as well as a higher mortality rate.

A Leapfrog press release announcing the survey results quoted a neonatologist who said that 19% of admissions at his children's hospital in 2011 were newborns who were delivered at a gestational age of 37 to 38 weeks.

Obstetrician-Gynecologists Should Say No

Despite being branded as an unsafe practice that drives up healthcare costs, early elective deliveries are still "rampant," said Leapfrog chief executive officer Leah Binder in an interview with Medscape Medical News.

Leapfrog CEO Leah Binder

Binder said such deliveries typically are scheduled as a matter of convenience for the patient, the obstetrician-gynecologist, or both. Sometimes, a patient chooses to have her particular obstetrician-gynecologist deliver her baby at week 37 if he or she plans to be on vacation after week 39 and a partner must take over the job, according to Binder.

"However, it's the responsibility of the obstetrician-gynecologist to ensure there's a safe delivery," she said. "They should be saying to their patients, 'No, you have to wait.'

"Most women, when they hear there's a danger to their baby, are not going to want to schedule [an early delivery]."

Binder said the ultimate solution is for hospitals to simply forbid early deliveries that are not medically indicated and then enforce the policy.

Leapfrog describes itself as the only national organization that makes hospital-specific data about early elective deliveries available. In 2011, roughly 1200 hospitals — about 1 in 4 — completed the survey.

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