Hospital quality watchdog The Leapfrog
Group issued a Call to Action in response to its new
findings that thousands of babies are electively scheduled for
delivery too early, resulting in a higher likelihood of death,
being admitted to a neonatal intensive care unit (NICU), and
various life-long health problems.
Despite the importance of this issue to women and babies, Leapfrog
said is the first national organization to make this information
public by hospital.
No set standards
The findings from 773 hospitals in Leapfrog's 2010 annual
hospital survey reveal significant variation among hospitals in
their rates of early elective cesarean section and elective
inductions, with some hospitals having ten times the rate of
others.
Leapfrog CEO Leah Binder said hospitals, health plans, providers,
and communities need to do more to protect women and babies from
this harmful practice. "And women need to protect themselves
by refusing to schedule their deliveries before 39 weeks without a
sound medical reason, and by knowing the facts about the hospitals
they plan to deliver in," she added.
Binder noted that currently only hospitals that report to
Leapfrog's annual hospital survey are making their rates of early
elective deliveries public. "Every hospital should publicly
report on their rate and actively prevent the practice, and every
woman planning to give birth should demand the information."
Caution urged
Experts, including those from the American College of Obstetricians and
Gynecologists (ACOG), Childbirth
Connection and the March of Dimes, caution that the amount of time
a baby needs to develop fully -- which includes having a fully
developed brain and other organs --is at least 39 completed
weeks.
Sometimes there is a medical reason to schedule a newborn delivery
before the 39th week -- for example, if the mother has high blood
pressure at the end of pregnancy or broken membranes before labor
begins.
However, Leapfrog finds many newborns are being "electively"
scheduled for delivery before the 39th week, meaning without a
medical reason, at alarming rates.
According to the group, hospital rates of early elective deliveries
range from less than five percent to more than 40 percent.
The 773 hospitals from around the country that voluntarily provided
Leapfrog with information on this measure reported over 57,000
early elective deliveries by cesarean section or induction during
the reporting period.
Variations
The variation in hospital rates has long been talked about in
the health care community, but Leapfrog's release of 2010 data is
the first real evidence that the practice of scheduling newborn
deliveries before 39 weeks without a medical reason is common and
varied among hospitals even in the same state or community.
For example, in the city of Los Angeles, hospitals reported rates
as low as 4 percent and as high as 29 percent. In Boston, Leapfrog
saw similar variation with some hospitals reporting near 0 and
others as high as 27 percent.
In light of these findings, Leapfrog, Childbirth Connection, and
the March of Dimes are working together to provide information
about the importance of every week of pregnancy with women,
purchasers, and others.
Awareness campaign
Leapfrog also announced a Call to Action to other leaders in the
health care community to prevent elective deliveries before 39
weeks.
So far, health insurance companies Aetna, CIGNA, UnitedHealthcare,
and WellPoint have all responded to the call and are collaborating
on an awareness campaign that includes three key messages:
- The last weeks of pregnancy are important
- There are risks for mothers and babies if births are scheduled before 39 weeks for nonmedical reasons
- Expectant mothers should investigate the rates of elective deliveries for hospitals in their community
Leapfrog's membership of employers and regional business
coalitions plans to help raise awareness by providing Leapfrog data
along with resources from Childbirth Connection and the March of
Dimes with their employee populations.
Leapfrog also plans to host two national Webinars for health care
professionals, focusing on the new 39-week toolkit developed by the
March of Dimes and its partners.
Critical period
Alan R. Fleischman, MD, senior vice president and medical
director of the March of Dimes said the last few weeks of pregnancy
are critical to a baby's health because important organs, including
the brain and lungs, are not completely developed until then.
"We thank Leapfrog for making this data available. A baby's birth
should not be scheduled before 39 weeks of pregnancy, unless their
health care provider says it's medically necessary. The 39-week
toolkit can help ensure that inductions and c-sections are done at
the right time and for the right reasons," said Fleischman.
Maureen Corry, executive director for Childbirth Connection, a
national advocacy organization that works to improve the quality of
maternity care, salutes Leapfrog for making hospital rates of
elective delivery accessible so women can make an informed decision
about where to give birth.
"Now we need to make the data available for all hospitals and
individual physicians and midwives. We are pleased to join
Leapfrog's Call to Action by providing women with evidence-based
resources on benefits, harms, and appropriate use of
labor induction, including tips and tools for avoiding an
unnecessary induction,” said Corry.
Setting goals
In 2010, Leapfrog's target for hospitals was a cesarean section
and/or induction rate of less than 12 percent of the total number
of non-medically indicated deliveries occurring between the 37th
and 39th week of gestation.
In 2011, Leapfrog will lower the target to five percent. This
change was made in part because 50 percent of reporting hospitals
were able to meet Leapfrog's 12 percent target in 2010 and 29
percent of reporting hospitals exceeded Leapfrog's target by
reporting rates of five percent or less.
Additionally, Leapfrog has identified several hospitals and health
systems, such as Hospital Corporation of America, which have
promoted and supported implementation of policies to deter doctors
from scheduling cesarean sections and elective inductions for
nonmedical reasons.
The group said this example suggests all hospitals can help
implement policies that improve adherence to evidence-based
care.
