Thursday, September 01, 2011
Posted by: Mark Tomlinson, MD, MBA
In a collaboration designed to give babies and their families the healthiest start possible, 17 hospitals in the region and throughout Oregon have agreed to discontinue early term elective deliveries beginning on September 1st. Before I talk about the reasons this initiative is important, let’s clarify a few things. “Early term” refers to babies born in the window between 37 and 39 weeks’ gestation. “Elective” deliveries mean inductions or cesarean sections that are not medically indicated.
First of all, why is it so important that elective deliveries be delayed until 39 to 40 weeks? We now know that important growth and development happens in the final weeks of gestation. Between 35 and 39 to 40 weeks, babies’ brains grow 30%. Their lungs and livers also complete important development. Babies born at less than 39 weeks are more likely to have vision and hearing problems after birth, be too small and have difficulty sucking and swallowing. Nationally, the rate of complications from early term deliveries is relatively low at 2 to 3%. However, these complications are preventable in the case of elective early term deliveries.
Early elective deliveries can cause other problems, as well. For example, when labor is induced in a pregnant woman before her body is ready, the delivery is more likely to result in a c-section. Babies born by c-section can have more breathing problems than those born vaginally. C-sections also lengthen hospital stays, increase complications for the mother and can cause complications in future pregnancies.
As individual providers, many of us don’t see the complications related to early term deliveries because, in most situations, everything works out fine for the mother and baby. This is why, as a profession, we’ve allowed these elective early term deliveries to creep into our practice. Maybe the mother is very uncomfortable during the last weeks of pregnancy, or there are relatives in town for the birth or the family really wants their own doctor to deliver the baby. Whatever the reason, this practice has gradually increased over time to the point that when you consider all the babies born in a region the size of Portland, the complications related to elective early term deliveries are significant. Nationally, several quality and regulatory agencies have begun to track and report individual hospital elective delivery rates before 39 weeks as one measure of quality.
It is important to point out that inductions and c-sections will still be performed when medically indicated. They may be performed even prior to 37 weeks if the health of the mother or baby is at significant risk. This initiative also does not apply to planned elective c-sections or inductions when a woman’s body is ready after 39 weeks.
Read more about why 39 weeks is best for your baby on the March of Dimes website. Watch Dr. Tomlinson's September appearance on Fox 12 explaining the end to early term elective deliveries.
Dr. Mark Tomlinson is a board-certified maternal-fetal medicine specialist who sees patients at Northwest Perinatal Center on the Peterkort campus near Providence St. Vincent Medical Center in Portland, Oregon. He is also the Regional Director of Obstetrics for Providence.