Hospitals Move To Curb Elective Early Deliveries

More hospitals in Massachusetts and across the country are saying no to elective deliveries of babies before 39 weeks unless medically necessary. Doctors cite increased health risks associated with early deliveries, not costs — though Texas' Medicaid program has stopped paying for such births.

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ROBERT SIEGEL, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel. Many women choose to have their baby before its due date. There are lots of reasons for doing that: to protect her or the baby's health, to make sure her regular doctor would be available, to fit work schedules and even to avoid or hit a specific birthday. But if that perfect day falls before the 39th week of pregnancy and there's no medical reason for an early delivery, many hospitals in Massachusetts are saying no, you have to wait. WBUR's Martha Bebinger has our story.

MARTHA BEBINGER, BYLINE: The number of early deliveries, from induced labor or C-sections, has been on the rise across the country for more than a decade now. Advances in medicine have created the expectation that babies born a little bit early will be fine, says Glenn Markenson, an obstetrician at Bay State Medical Center in Springfield, Massachusetts.

DR. GLENN MARKENSON: Before the benefit of the neo-natal intensive care unit, people were very, very conservative and would not induce or do C-sections before 39 weeks. But as they saw how well babies were doing, there was a creep down from 39 weeks to 38 weeks, maybe even sometimes 37 weeks.

BEBINGER: But babies are in these expensive neonatal units because they weren't ready for delivery.

DR. LAUREN SMITH: Early term infants have higher rates of respiratory distress. There are also issues with feeding.

BEBINGER: Dr. Lauren Smith is the medical director at the Massachusetts Department of Public Health. She says babies born before 39 weeks may also have developmental issues. A study in the June issue of Obstetrics and Gynecology shows a baby's risk of dying at 37 weeks is almost double that of an infant born at 39 weeks.

SMITH: When you add up the increased risks, then you can't justify it.

BEBINGER: That's a big reason why a growing number of hospitals in Massachusetts and across the country are saying no to elective deliveries before 39 weeks. Many hospitals are making the change with help from the March of Dimes and its campaign to end early deliveries that are not medically necessary.

(SOUNDBITE OF BABY COOING)

BEBINGER: The change is happening quietly and some new mothers don't like it. Lisa Coulouris sits on her hardwood kitchen floor with the Moms Club of Reading baby playgroup.

LISA COULOURIS: The bottom line is women should have, you know, 99 percent of the say of what happens with their pregnancy and their bodies.

BEBINGER: Coulouris delivered twins eight months ago after complications that lead to an emergency C-section. She does not like the idea of hospitals telling women they must carry to at least 39 weeks.

COULOURIS: You're already out of control of your body, you know. So, at least to know that when you go to your doctor's office, if say, look, we're at 37 weeks; I feel like I'm ready. I'm just very nervous about this experience. Can we just go into a C-section? To know that I would have that choice would just make me feel better. You know, but to take it away from me also adds to the anxiety of just being pregnant.

BEBINGER: Across the room, Jennifer Brickely agrees that doctors need to take a mom's emotional state into account, but she is bothered by what she calls convenient deliveries.

JENNIFER BRICKELY: In recent years, it's kind of gotten in line with like the spa appointments or the hair appointments.

BEBINGER: Brickley's baby, Audrey, grabs the microphone as mom says the timing of a delivery should be based on medical evidence.

BRICKELY: So, I agree with what they're doing. I think probably it's a lot of cost involved probably driving it as well.

BEBINGER: Well, not exactly. Doctors in Massachusetts who are trying to end early elective deliveries say they aren't doing it to save money. Their focus is on good medical care.

DR. JEFF ECKER: This is a recent list here. There are four patients on it.

BEBINGER: At Massachusetts General Hospital, Jeff Ecker, a high-risk obstetrician, reviews the hospital's upcoming schedule for early inductions and C-sections to see if they are all medically necessary.

ECKER: The first is having a planned delivery just after 37 weeks because of a complication that places the pregnancy at increased risk for stillbirth. Second patient, this is a mother that has preeclampsia, high blood pressure. So, again...

BEBINGER: Ecker ultimately approves all four of these early deliveries. He says the decisions are easy: no, if the date is clearly a choice; or, yes, if the mother or baby is very sick.

ECKER: And in between are sometimes shades of gray - how high is the blood pressure? How small is the baby?

BEBINGER: Privately, some obstetricians worry about how hospitals that stop early elective deliveries will handle cases that aren't clear cut. Ecker says once doctors and patients at Mass General review all the issues, there is little disagreement these days about what is an early elective delivery.

ECKER: Our goals are to make it virtually a never event, that there will not be truly elective deliveries less than 39 weeks and we're pretty much there.

BEBINGER: In the health care world , a never event is something like a medical mistake that shouldn't happen. More and more hospitals aren't getting paid for these never events. That's not happening yet with early elective deliveries in Massachusetts but in Texas, the Medicaid program has stopped paying for C-sections or induced deliveries before 39 weeks unless they are medically necessary. For NPR News, I'm Martha Bebinger in Boston.

SIEGEL: And that story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.

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