Central Ohio hospitals to deter early deliveries

August 5, 2015

CelebrateOne accomplishment: Central Ohio hospitals to deter early deliveries

By Misti Crane

The Columbus Disptach

Friday, June 12, 2015

A week or two more in the womb can mean the difference between taking your baby home after she’s born and visiting her in the neonatal intensive-care unit.

The final weeks of pregnancy are eventful. One-third of brain development transpires in the last month of a full-term, 39-week pregnancy. Babies gain weight and build muscle in those weeks. Their lungs get ready for the world.

During the past decade, Ohio hospitals have seen a drop in the number of early deliveries for non-medical reasons such as a vacation-bound doctor or a family who wants a birth date that coincides with Grandma’s visit from faraway.

To ensure that those numbers stay low, central Ohio birthing hospitals recently agreed to policies that prohibit inductions and cesarean sections before 39 weeks when they are not for the health of mom or baby.

Statewide, 5 to 6 percent of deliveries are early cesarean sections or inductions with no documented medical cause, according to Ohio Department of Health data.

The percentage has hovered there for a couple of years, down from more than 15 percent a decade ago. A statewide effort called the Ohio Perinatal Quality Collaborative began in 2008 to push back against unnecessary early delivery, and a sharp decrease followed.

Central Ohio birthing hospitals have even lower elective early-delivery rates than those seen statewide.

But they don’t want the numbers to creep up again, as often happens after a quality-improvement initiative becomes old news.

So the Central Ohio Hospital Council sent letters to doctors this week explaining new community-wide standards for avoiding deliveries before 39 weeks in the interest of healthy babies and lowering the county’s high infant-death rate.

Doctors who want to schedule an early delivery but can’t point to one of a variety of reasons on an approved list will have to justify their decisions.

The council also developed a patient-education flier for women visiting hospital prenatal clinics that emphasizes the benefits of waiting until full-term.

The community-wide goal is to keep elective early deliveries not on the list of medically justified reasons to 3 percent or less. The list is maintained by the Joint Commission, an independent nonprofit organization that accredits hospitals.

Reaching that goal shouldn’t be tough: The community is already there.

For 2014, the Mount Carmel Health System and Ohio State University’s Wexner Medical Center reported 1.3 percent and 2.8 percent, respectively. University Hospitals East had no births that fell into that category, a spokeswoman said.

OhioHealth, which provided hospital-specific data for its Franklin County hospitals, saw rates as low as 1.1 percent at Doctors and as high as 2.8 percent at Riverside Methodist.

Scientific evidence showing the potential harm of early delivery is strong and should outweigh personal scheduling preferences of doctors or families, said Mickey Johnson, service-line vice president of women’s health for the Mount Carmel Health System.

There are cases that fall outside the list of medical reasons for early delivery that are justified. And in those cases, obstetrics leaders will talk with the scheduling physician.

Jenny Brehm, nursing director of obstetrics and gynecology at Wexner Medical Center, said schedulers won’t book early inductions or C-sections without agreement that they are happening for medical reasons.

She said she doesn’t expect blowback from doctors because they’ve long been working on lowering these numbers and understand the importance of protecting infant health.

Moms, especially those who delivered early and without trouble before, might be surprised.

But once they learn that it’s best for their babies — that early birth might make it hard for newborns to eat or breathe — waiting is an easy sell, said Dr. Andrew Bokor, OhioHealth Grant Medical Center’s chairman of obstetrics and gynecology.

There are gray areas in medicine, and it would be misguided to force doctors to adhere to a list when their experience and a patient’s circumstances point to trouble if a delivery doesn’t happen early, said Dr. Jay Iams, an expert in maternal-fetal medicine and professor emeritus at Ohio State.

For example, a woman’s history of preeclampsia (dangerously high blood pressure late in pregnancy) and the resulting stillbirth could prompt her obstetrician to advise that early delivery is in the best interest of mom and baby, he said.

“You can’t play medicine completely by the cookbook,” Iams said, adding that the list of reasons for early delivery has changed over time and probably will continue to evolve.

The goal behind the effort is to create “a culture of safety for the mother and baby, but not a culture of convenience,” he said.

While some babies born early are perfectly healthy, others are at a significant disadvantage, Iams said. There’s no good way to predict which babies will fall into which category, he said.