The Leapfrog Group, a nonprofit organization that focuses on hospital standards asked hospitals across the US to voluntarily report their rate of non-medical (elective) inductions and cesarean births before 39 weeks.
Ok. First let’s define why elective inductions/cesareans before 38 weeks are bad. The biggest reason is that the babe isn’t finished cooking yet. Her lungs and brain are still developing. More of these babies go to the Neonatal Intensive Care Unit (NICU) and more are at risk for health problems. An early induction also carries a high risk for cesarean birth which increases danger to mama and baby. Leapfrog also factors the cost-saving benefit to avoiding early inductions here.
These numbers do not reflect early inductions/cesareans for medical reasons. Medical reasons include preeclampsia or premature rupture of membranes. These are purely elective (convenience–for the parents or the OB, concerns of big baby, tired of being pregnant, etc).
Would you like to check out your hospital?
For the local families:
1) I’m surprised AnMed was willing to admit their non-medical early induction/cesarean rate is a crazy high 67.3%!
2) I understand St. Francis has a new policy for 2009 that disallows these early births prior to 39 weeks. Good for them with their 2% rate! Maybe they will also catch up on the evidence for other things soon too. Like what? Oh, maybe like uninterrupted skin-to-skin contact after birth or vertical positions for birth or…the list goes on.
3) Not specific to our hospitals but good to know, in general, the average length of gestation for a first time mom is 41 wks 1 day. So if a baby is scheduled to be born at 38 weeks, that baby is premature. Whether he meets the medical criteria for prematurity, he had potentially had several more weeks to grow and develop.
4) Finally, beware the back-door induction. The what? Nancy New-Mommy goes in for a 38 week visit. Dr. Sneaky Sneakyscrubs checks her and exclaims, “you’re 2cm dilated and 75% effaced! are you feeling any contractions?” Nancy says, “well, I have been feeling some cramping. I think.” Dr. Sneakyscrubs: Let’s go do a non-stress test to see what is happening. Nancy is surprised that the monitor shows she is having some contractions and they seem to be coming every 7 or so minutes. Dr. Sneakyscrubs returns to say, “Congratulations, you are in labor! Let’s get you over to the hospital. We’ll start you on a very low dose of pitocin to help things along.” Fast forward: Nancy’s membranes are artificially ruptured, she gets an epidural to help cope with the pain of the pitocin, antibiotics because her membranes are ruptured, more pitocin because the epidural slowed things down, oxygen because baby distressed from the pitocin, and a cesarean for failure to progress and prolonged rupture of membranes. Was she ever in labor to begin with?
Ladies, if you’ve ever attended one of my childbirth classes, you know my mantra: Keep your knickers on. Keep your knickers on at your 38, 39, 41 week OB visits. There is nothing your OB or midwife needs to know from your cervix unless you need to know your Bishop’s score for an induction decision. (There is an app for that by the way).
Inexplicable Ways 