Because of health risks for mother and baby, docs say it's best to wait
By Nick Tabor, New Era Senior Staff Writer
Women often
choose in advance when to have their babies delivered.
Sometimes it’s because they feel serious physical discomfort
in their final weeks. Other times they want to coordinate with the schedule of
a visiting relative or hit a certain birthday.
But medical experts say this
endangers babies’ development and even their lives, and it often harms mothers.
Now the Kentucky Hospital
Association is working with 15 of its member hospitals, including Jennie Stuart
Medical Center ,
to cease the practice except when it’s necessary. Another 15 or so may soon
start participating.
Medical staff at Trover Regional
Medical Center
in Madisonville ,
who ended early elective deliveries in 2010, are helping lead the effort.
The Center for Women’s Health at
Trover doesn’t just discourage patients from choosing early deliveries, said
LeAnn Todd Langston, the center’s nurse manager.
“That’s not an option,” she said.
“Because it’s not evidence-based, and it’s not best in care.”
The hospital association has
measurable goals to bring its members along and help educate their patients,
said Elizabeth Cobb, the hospital association’s vice president of health
policy.
Dangerous trend
Between 1990 and 2006, the
national rate of elective labor inductions jumped from 9.5 percent to 22.5
percent, according to
publications from The Leapfrog
Group, a nonprofit dedicated to reducing early deliveries.
Researchers blame several
factors. Women incorrectly believe it’s safe to deliver as early as 36 weeks;
hospitals have developed a culture of encouraging this practice; and doctors
sometimes make more money by scheduling deliveries, the Leapfrog Group reports.
Cobb added that technology has
made it seem safer.
“I think that we take those risks
for granted, maybe, because hospitals are providing such exceptional care,” she
said.
But the risks remain serious.
Women induced in the 37th or 38th week have higher risks of needing cesarean
sections, which can lead to additional cesarean sections with increasing
dangers, the Leapfrog Group reports.
Early deliveries more often
produce bleeding and wound problems, anemia, endometriosis and urinary tract
infections, studies have shown. Babies born early have higher rates of
mortality and disease, respiratory problems and placements in intensive care,
according to a 2009 obstetrics study.
Early delivery often means more
hospital time for mothers and babies.
Trover’s experience
Trover started in 2010 its
CenteringPregnancy program, which aims to get women more involved in their own
prenatal care. Trover staff re-examined the whole paradigm of treatment and
sought ways to use more evidence-based care.
In 2010, Trover changed its
policy on early deliveries: It would only use them when there was a compelling
reason, such as safety. Convenience didn’t count.
“It was a pretty staunch, or
hard-stock, approach that we took,” Langston said.
But staff members were ready for
the change because they already had an innovative mindset, Langston said. And
new mothers adapted when doctors and nurses explained their reasons.
Now, from her first visit with a
Trover obstetrician, the woman starts learning about brain development and the
importance of a full-term pregnancy. She learns every week counts.
A tough transition?
The Kentucky Hospital Association
started a quality improvement program earlier this year. It’s part of a
national endeavor to reduce hospital-acquired conditions by 40 percent and
readmissions by 20 percent before 2014.
In Kentucky , 101 hospitals are participating,
Cobb said.
One of the program’s 10 focus
areas is obstetrics-related harm, especially from early deliveries, Cobb said.
The hospital association is using
a toolkit that the March of Dime publishes. The toolkit played a crucial role
in Trover’s conversion, Langston said. It involves changing hospital policies,
educating hospital staff about risks of early deliveries, and educating
patients.
All the hospitals are submitting
numbers each month, Cobb said.
Jennie Stuart just submitted
base-line statistics last month. Staff members are still determining how
they’ll make the changes, spokesman James Goss said.
The Trover team schedules a
conference call every month. Hospital staff all over the state can compare
notes on how they’re progressing.
It can be a tough transition,
like ripping a Band-Aid off, Langston said. So it reflects well on nurses and
doctors who are participating.
“I think the hospitals who select this measure are a lot
like us, and they’re very proactive about improving outcomes,” Langston said.
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