Elective Inductions, Cesareans, and Preterm Birth

20 Nov

November is Prematurity Awareness Month when the March of Dimes (MoD) encourages care providers and the public to focus on the high number of preterm births in the United States and what can be done to reduce them. The March of Dimes, along with state and national health services are concerned that increasing elective inductions and scheduled cesareans may be contributing to the rising number of babies born preterm. Premature birth is the number one cause of newborn death in this country.

In addition to encouraging women to stop smoking, avoiding multiples from fertility treatments and providing progesterone treatments for women with a history of preterm birth, the MoD recommends avoiding unnecessary cesareans and inductions before 39 weeks and encourages women with a healthy pregnancy to wait for labor to begin on its own.

Between 1990 and 2006  the number of babies born after 39 weeks decreased sharply and the number of babies born between 36-38 weeks gestation rose sharply. Experts associate this trend with increasing rates of induction of labor and cesarean sections. An integrated health care system based in Salt Lake City, Utah reported that in 2001, 28%  of their elective deliveries were performed prior to 39 weeks.

In 2008 12.3%  of all U.S. births were preterm. Based on records from the National Center For Health Statistics, the March of Dimes developed a score card for national and state preterm birth rates. Comparing the  national preterm birth rate to the Healthy People 2020 goal of 7.6%  the MoD gave the U.S. a “D” grade.

Preterm birth is defined as a live birth before 37 completed weeks gestation. A baby born between the 34th and 36th week of pregnancy is considered  late preterm. A full term pregnancy is 40 weeks. When cesareans are scheduled or labor is induced there is a margin of error in pinpointing fetal maturity. Being born only one week earlier can make a difference in terms of complications babies are likely to suffer.

The number of cesareans increased by 71% between 1996 and 2007. The rate rose for women in all age, racial and ethnic groups. The National Center for Health Statistics  found that non-medical factors including physician practice style and women’s preferences contributed to the widespread and continuing rise of cesareans (NCHS Data Brief No. 35, March 2010).

A large percentage of the increase in preterm and late preterm singleton (one baby) births between 1996 and 2004 occurred among women who delivered by c-section.

The last few weeks of pregnancy are extremely important to a baby’s health because many organs, including the brain and lungs, are not completely developed yet. Babies born a few weeks too soon can face serious health challenges and are at risk for lifelong disabilities, such as cerebral palsy, lung problems, vision and hearing loss, and learning disabilities.

Expectant mothers however, are not aware of the importance of keeping the pregnancy full term. In a recent U.S. survey over 90% of women believed that giving birth at 39 weeks was safe, unaware of the crucial brain development that occurs in the last weeks of pregnancy. Women who agree to or choose to induce labor or schedule an elective cesarean don’t consider the additional interventions and days in the hospital that premature babies often need nor are they aware of the financial costs.

Elective inductions also increase the risk for cesarean section.

A national campaign is in full force to educate care providers, hospitals, and the public about the importance of maintaining a full term, 40 weeks, pregnancy. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the national body that accredits hospitals, recommends that hospitals track and reduce their induction rates as one criteria to gain accreditation.

On November 15, 2010 the Mineapolis – St. Paul Star Tribune reported that the Minnesota State Department of Human Services is leading the nation in discouraging birth by convenience. It has  created a policy against elective, non-medically indicated inductions by asking hospitals to establish policies to reduce convenience inductions by the year 2012.

Although the national preterm birth rate dropped 3% in the last two years, the U.S. still has one of the highest preterm birth rates in the world. Hopefully, the progress that has been made in the last two years will continue.

For additional information on the impact of labor induction and preterm birth see, Labor Induction Exposed, posted November 15, 2010 on Mother’s Advocate Blog.

Sources for this article:

March of Dimes/California Maternal Quality Care Collaborative, Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age, A California Tool Kit To Transform Maternity Care.

March of Dimes, 2010 Prematurity Birth Report Cards

March of Dimes, www.prematurityprevention.org

March of Dimes, Professional Resources

Educational Resources

U.S. Surgeon General Dr. Regina Benjamin’s message on preterm birth, video

March of Dimes, Why The Last Weeks of Pregnancy Count

Lamaze International, Let Labor Begin On It’s Own

Mother’s Advocate, Let Labor Begin On It’s Own, video

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