December 5, 2010: In the final weeks of pregnancy, doctors say, a lot of women are eager to give birth. Maybe their husbands are in the military, about to be deployed. Maybe they’re feeling huge, hot and exhausted.
Sympathetic doctors sometimes oblige, inducing labor or scheduling a C-section a little early if they think the pregnancy is advanced enough. Besides, many doctors would rather avoid a midnight delivery, numerous studies suggest.
But new data showing that delivery even a week or two early can lead to significant health problems are fueling efforts in Florida and around the nation to stop preterm births for the sake of convenience.
“We’re correcting a problem,” said Dr. Robert Yelverton, chief medical officer of Women’s Care Florida, a Tampa-based group of more than 100 ob-gyns. “There should be justification for delivery before 39 weeks.”
For years, many doctors have considered a pregnancy full term at 37 weeks. Indeed, most babies born at that point do just fine. But the new data are showing that babies born at 37 and even 38 weeks have much higher rates of respiratory problems, pulmonary hypertension and admissions to neonatal intensive care units than those born at 39 weeks. Florida’s rate of preterm births is so high — 14 percent — it recently earned its third-consecutive “F” from the March of Dimes.
So the Florida Perinatal Quality Collaborative has just been created to work with the March of Dimes and six Florida hospitals, including St. Joseph’s Women’s in Tampa, on a yearlong project to reduce or eliminate the practice of elective early inductions.
Given that 37 weeks has been the standard for years, changing to 39 weeks will be a challenge, said Dr. John Curran, a neonatologist and senior executive associate dean at the University of South Florida College of Medicine who is serving in the collaborative.
“Physicians often practice as they were trained, which goes back a fair number of years,” Curran said.
Yelverton, an ob-gyn for more than 30 years and a collaborative member, said medical textbooks still define full term as 37 weeks.
But doctors are learning more about pregnancy and fetal development. Advances in ultrasound technology have led to more accurate gestational dating than the old method of counting back to the last menstrual cycle.
“The practice of obstetrics should be dynamic and changing to reflect best practice,” Curran said. “We’re trying to move things forward to do better for mothers and children.”
Many factors contribute to preterm births, including maternal smoking, obesity, lack of health insurance and poor or no prenatal care. Fetal distress, maternal high blood pressure, diabetes or other chronic conditions are a few of the compelling reasons for an early delivery.
But many births are early because of convenience, research suggests.
In a 2009 study by the American College of Obstetricians and Gynecologists, women in Utah who had labor induced were more likely to deliver on weekdays than on weekends, and during the day or early evening hours. An evaluation of deliveries in New York found that in more than a quarter of induced deliveries, no medical reason was documented.
The American College study noted that some doctors use elective inductions to more efficiently manage work and vacation schedules.
The Internet is full of discussion boards on the topic, especially involving women who have husbands in the military. Some sites offer ways to help prompt labor, such as walking, drinking castor oil and having sex.
“We have to educate the consumer and the families to have the baby at the right time, not ahead of time,” Curran said.
Curran said the Florida effort will likely take a cue from California, Ohio and Utah, which all initiated programs to halt elective inductions, with positive results.
When Utah’s Intermountain Healthcare system rolled out its plan, doctors feared losing control and nurses feared getting into arguments with doctors.
But once they saw the data, they bought in. Within six months, the percentage of elective deliveries before 39 weeks decreased from 28 percent to less than 10 percent. After six years, the rate dropped to less than 3 percent.
One of the main components of the program: Doctors who want to do an elective delivery must get permission from their hospital ob-gyn department head or attending perinatologist.
The six participating Florida hospitals are gathering their own data on babies born before 39 weeks. In January, they will start educating doctors, nurses and patients about the need to wait. Doctors will have to document the medical reason for any inductions before 39 weeks.
Yelverton has found plenty of support for the plan among doctors and other staff at hospitals he has visited. He noted that most births are full-term.
“It’s not that most doctors weren’t practicing this in the first place,” Yelverton said. “But now, there’s much more emphasis on it. And science is behind it.”
Emily Grey of Largo is 38 weeks pregnant with her first child. She says she wouldn’t consider an early induction of labor, nor is it offered at the Breath of Life Women’s Health & Birth Center in Largo, where she is expected to deliver.
“I know lots of women who are induced before 40 weeks. You get tired. I understand that,” said Grey, 23. “But it’s not that long. I have to live with this baby for the next 18 years, so another two weeks is not that big a deal.”
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.