A safe and healthy delivery: Every week counts

May 21 2014
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Parents want to give their baby the best start possible. Expectant moms often focus on eating right, exercising and receiving prenatal care. And in the last three years, many moms-to-be and their doctors have added another healthy practice — avoiding early, elective deliveries as well as elective cesarean sections at any gestational age. That’s because word is spreading that these simple steps can help reduce health risk for moms and babies.

Some early deliveries and C-sections are unavoidable. Fortunately, medicine has advanced to care for moms and babies in these cases. However, a baby may be delivered by C-section or their delivery dates are being selected too early without a medical reason. According to researchers at the Mayo Clinic, 10 to 15 percent of all deliveries in the United States are elective and early. (Thirty-nine completed weeks of pregnancy is recommended to give a baby the most time for development.)

Babies that are born early, even just one or two weeks early, can have complications. Research shows that infants born at 37 weeks have four times the risk of having respiratory distress. They also have three times the risk of severe infection and twice the risk of medical problems or death. The 37-week-old infants were more than twice as likely to need neonatal intensive care lasting five days or more. Babies born at 38 weeks fared better, but still had significant health problems and required more time in the neonatal intensive care unit (NICU) compared to babies born at 39 weeks.

Research shows that infants born at 37 weeks have four times the risk of having respiratory distress. They also have three times the risk of severe infection and twice the risk of medical problems or death.

Several factors lead to the acceptance of early elective deliveries. Some patients like setting a date based on their schedules. Convenience for the doctor also plays a role. Another driver in this trend is the increase in the rate of C-sections. Once a woman has one C-section, the probability is high that her subsequent deliveries will also be C-sections. These surgical procedures need to be scheduled and this, in and of itself, introduces the risk that it will be rescheduled early for the reasons cited above.

Organizations like the American Congress of Obstetricians and Gynecologists and many obstetricians and pediatricians have advised against early elective deliveries. Joanne Armstrong, M.D., M.P.H., senior medical director and head of Women’s Health at Aetna, said a major effort must be put into educating patients about the dangers.

“The risks speak for themselves, but many parents and doctors are not aware,” said Armstrong, who is board-certified in obstetrics and gynecology. “Some hospital consent forms don’t say anything about the risks of delivering before 39 weeks. More hospitals are adding that information. This helps people understand that an early delivery can be harmful to the baby.”

Aetna has partnered with groups like the March of Dimes and the Leapfrog Group, an employer-based coalition, to help educate doctors and patients on the risks of early delivery. And the efforts are paying off.

In two years, Aetna has seen early, elective deliveries drop from 11 percent to 5 percent among hospitals that adopted best practices including maternal education, informed consent and hospital policies that eliminate the option to schedule early elective deliveries. The number of babies who required NICU care fell even more dramatically. One hospital system in Georgia saw a 60 percent drop in NICU admissions after setting guidelines for electively scheduled deliveries prior to 39 weeks, as well as quality improvement programs.

“We want to help women and their doctors be informed about the best clinical practices that drive improved safety, healthier outcomes and lower costs,” Armstrong said.