June 16 might seem like a great day to give birth, but planning a C-section or being talked into it for convenience (of either the patient or the physician) may be bad for the baby. Tallahassee Memorial Hospital has decreased the number of preterm births—and thus admissions to neonatal intensive care units and infants with health problems—by cutting elective induction and C-sections over the last three years.
The Hospital saw early delivery rates go from 44 percent to less than 37 percent. The statewide rate is 38 percent and has gone up yearly for the last few years; the national rate is 32 percent. The hospital has also reduced first time delivery C-section from 22 to 15 percent—compare to 25 percent for Florida as a whole. A rate under 20 percent is considered good by childbirth advocates.
Many obstetricians think that deliveries in the 37th or 38th weeks are fine since they don’t usually involve serious complications for the infants. They allow both patient and physician more control over their schedules, and inductions can allow physicians to see more patients in a day. But emerging research indicates that any birth before 39 weeks involves potential problems, including respiratory distress. The later the delivery, the fewer admissions of newborns to intensive care, and there is no increase in mortality by waiting until 39 weeks to induce or schedule a C-section.
The Tallahassee Memorial program was brainchild of a neonatologist who saw a relationship between the sick babies he cared for and how many were delivered by elective inductions or C-sections. Now, physicians can’t schedule deliveries before 39 weeks without a medical reason. The hospital also recommends that physicians not induce until a woman’s Bishop’s scale score—related to fetal position and cervical dilation—indicates she’s ready. Noncompliant physicians get reminders, and the hospital has few outliers among their obstetricians.
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