Naperville Sun
Edward to ban elective deliveries before 39 weeks
By Kathy Millen
Jan. 6, 2011
When it comes to deciding the right time to deliver a baby, staff members at Edward Hospital think Mother Nature usually knows best.
Edward is one of six Illinois hospitals chosen to be part of a March of Dimes pilot program calling for a halt to elective deliveries before 39 weeks of pregnancy.
The program, which started Monday, makes use of a March of Dimes tool kit providing information, research and education materials to help health care providers ensure inductions and C-sections are done at the right time and for the right reasons. Hospital staff has trained in the use of this kit, incorporated materials in prenatal classes and posted them at www.edward.org. Physicians also are making patient education materials available in their offices.
Relevant data will be collected throughout the year and submitted to the March of Dimes.
Pat Bradley, obstetrics director at Edward Hospital, said the number of elective deliveries before 39 weeks has gone up dramatically during the last 10 years, and that can be detrimental to babies.
"When there is no medical indication, the last weeks of pregnancy are important for the growth and development of the baby," she said. "... The longer the baby can stay in, the better it is as long as there is no medical reason to do otherwise."
Neonatologist Dennis Crouse agrees. Chairman of the committee that oversees the March of Dimes project, he said a baby's brain, lungs and other physical functions still are developing during the last few weeks of gestation. While the medical community previously thought it was OK to deliver a baby a few weeks early, recent research indicates otherwise.
"On closer inspection, that wasn't the case," said Crouse, director of the neonatal intensive care unit at the University of Illinois Medical Center Chicago. "These infants have a much higher risk of being admitted to the intensive care unit. They have a much higher risk of having respiratory disease. Their hospital stays are usually much longer. It interferes with breast-feeding and there is evidence long term these infants may have an increased risk of some neurological issues."
Crouse, who also is a clinical professor of pediatrics and a director of the UIC Perinatal Center, said the American Congress of Obstetricians and Gynecologists sounded the alarm several years ago that, unless medically necessary, babies shouldn't be delivered before 39 weeks of gestation. While many doctors didn't heed the warning, some hospitals did. Those restricting pre-term elective deliveries have reported a reduction in health problems for both babies and moms. Mothers who deliver pre-term run a higher risk of having a Caesarean section, which can result in complications.
Dr. Peter Weeks, medical director of obstetrics and gynecology at Edward Hospital, said he hopes the results at Edward will be "immediate and dramatic." He said since introducing the March of Dimes educational materials to staff members several months ago, he said he's already noticed doctors are changing their behaviors and informing patients about the wisdom of staying pregnant longer.
"These results are proven, redemonstrated in different studies and dramatic, and that is what is so convincing," he said. "It's motivation for us to decrease the elective deliveries, and in doing so, decrease complications to babies."
Based on data from these hospitals, participants in the 2011 March of Dimes project can expect to reduce pre-term births and admissions to the NICU by 15 to 20 percent, Crouse said. That is significant from both a health and cost perspective. The typical hospital bill for a full-term baby is about $2,000, he said. That amount is at least 10 times greater when a baby is in the NICU.
Seventeen Illinois hospitals applied to be part of the March of Dimes program. Others making the cut are Decatur Memorial Hospital, St. Elizabeth's Hospital in Belleville, St. Joseph Hospital in Breese, Katherine Shaw Bethea Hospital in Dixon and the University of Illinois Hospital at Chicago.
Also participating are five hospitals in each of four other states: California, Texas, New York and Florida. The "Big Five" states account for almost 40 percent of the deliveries in the U.S.
About 3,500 babies are delivered at Edward Hospital each year, with 28 percent of these births taking place before 39 weeks of gestation. Half of that number is elective. Reasons vary. The father may be leaving town or is being deployed by the military. The mom may want a particular doctor to deliver her child or might want to end pregnancy-related discomfort. Some moms with a history of rapid labor fear they won't get to the hospital in time. Others are trying to juggle child care or extended family issues.
"We've become cavalier about deliveries prior to 39 weeks," Weeks said. "... We are trying to educate the patients to ask less for these deliveries and encourage doctors not to do them."
Jennifer Yap de Venegas of Plainfield said she and her husband, Adolfo, never would have considered an elective delivery in the births of their two sons, 3-year-old Alex and Jacob, who was born Jan. 2 at Edward Hospital.
In fact, she struggled to make sure she carried Jacob full term. Showing signs of premature labor in late August, she was hospitalized for more than a month before being released in October to finish her pregnancy at home in bed. A nursing student, she had to temporarily drop out of school.
Knowing all that could have gone wrong in her own case, she said she favors Edward Hospital's ban on elective deliveries prior to 39 weeks gestation. She said a baby's well-being should come before convenience.
"I think (the ban is) wonderful," she said. "I think it's going to help. I think it will control better those who are not thinking of the baby as their No. 1 priority, whether it's the parents or the doctor, whoever is trying to schedule this to be a more convenient event.
I hope it will succeed in keeping babies out of the NICU and having all these complications from coming out too early."
A recent study shows the need for expectant mothers to become better educated about the importance of carrying full-term, Bradley said. When they were asked at what gestational age is it safe to deliver a baby, about 70 percent responded it was OK after 36 weeks.
"There are always going to be some reasons you'll have to take into consideration," Bradley said. "But we feel if women are more educated about the benefits to the baby, they will choose to stay pregnant longer when it's appropriate."
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