PROVIDENCE HEALTH & SERVICES
There are many legitimate reasons to induce a birth before term. A nonrefundable plane ticket is not one of them.
As chief of obstetrics and gynecology at Providence Tarzana Medical Center in Tarzana, Calif., Dr. James Danielzadeh has heard many excuses to deliver a baby before 39 weeks gestation — the doctor has a flight, the mom can't bear the discomfort, the baby looks big.
But mounting evidence shows that elective deliveries prior to at least the 39th week can lead to costly health complications — 39 to 42 weeks is considered a full-term pregnancy. That's why Providence Health & Services, Southern California, now requires physicians to wait until week 39 to induce labor or schedule a cesarean section. The result is clear — more full-term births mean fewer trips to the neonatal intensive care unit.
"Since we've implemented this policy, there has been a reduction of admissions because that week can make a real difference," said Danielzadeh.
Evidence shows babies delivered between 37 and 39 weeks can struggle to feed or can suffer respiratory issues. In response, numerous organizations from the March of Dimes to the American College of Obstetricians and Gynecologists have called for an end to elective deliveries prior to week 39.
And yet, a recent World Health Organization report showed premature births have increased worldwide and that one in 10 babies is born prematurely across the globe. In America, the Department of Health and Human Services reports more than half a million infants are born prematurely each year, a trend that has spiked by 36 percent during the last 20 years. Up to 10 percent of all deliveries are induced before week 39 for no medical reason.
But at Providence Tarzana Medical Center as well as Providence Saint Joseph Medical Center in Burbank, Providence Holy Cross Medical Center in Mission Hills and Providence Little Company of Mary Medical Center Torrance — all in California — hospital leaders review every birth that occurs before week 39 to confirm medical need.
"If the doctor can give me a reason medically like mom has high blood pressure, of course the baby is delivered," said Danielzadeh. "They may go to the NICU, but they're better off outside of the womb than inside. Those are not the ones we're talking about. We're talking about the ones where mom and baby aren't having any problems. At first, we would bring in doctors and reinforce why we are doing this. But now that we've done our education, it's at almost zero. It's very rare now."
Danielzadeh concedes some doctors initially resisted the policy. Like Danielzadeh himself, they were taught it was safe to deliver a baby after 37 weeks.
"Moms would be talked to, 'How about we get you delivered with an induction of labor' or, if they had had a previous C-section, a C-section. And those babies would come out weighing six, maybe seven pounds. But they would not act okay."
So they would be transferred to the NICU where, for the most part, they did fine. But there was a cost.
"There is the emotional and financial cost to the parents and the cost to the system," said Danielzadeh. "The doctor didn't always get the full picture of what the mom went through being separated from the baby" in the NICU.
But NICU nurse Lori Delgado did. Some 30 years of experience have taught her that moms should wait to deliver. She has seen a dramatic drop in babies born between 37 and 39 weeks since the policy took effect.
"It was so hard for the parents," said Delgado. "These were big babies, but many times they had respiratory issues because a lot of early inductions end up in C-sections; and C-sections don't allow all of the fluid to come out of the lungs."
Other babies lacked the endurance to feed effectively, which could frustrate moms who are new to breast-feeding.
"We push for breast-feeding and really try to facilitate it. But the separating can make it hard," said Delgado. "I think the moms didn't always understand the consequences" of an early induction. Nor, according to research published in 2009 in the journal Obstetrics & Gynecology, do most women know the optimal gestation for an infant.
Researchers asked 650 women nationwide who had recently given birth about the "earliest point in a pregnancy that it is safe to deliver a baby, should there be no other complications requiring early delivery," and 51.7 percent choose 34 to 36 weeks gestation; 40.7 percent choose 37 to 38 weeks; and only 7.6 percent chose 39 to 40 weeks.
But Danielzadeh has found women will willingly delay delivery once they understand the potential risks of carrying their baby for a shorter term.
"When we explain it to them, they are totally, 100 percent on board," said Danielzadeh. "Like if a woman is experiencing back pain, I'll explain, 'Look, it's back pain, but it's not really abnormal, and you're giving baby another week.' Once they understand, they want what's best."