Experts Call on Hospital Leaders to Voluntarily Implement Quality Review Programs
WHITE PLAINS, N.Y., DECEMBER 16, 2008 – The continuing rise in the rate of Cesarean deliveries in the United States may be a factor in the dramatic increase in preterm births, according to maternal and infant health experts speaking today at a March of Dimes luncheon for reporters.
They described premature birth as the number one health problem for babies in this country, and called on hospital leaders to voluntarily review all c-section births and inductions of labor that occur before 39 weeks gestation in an effort to reverse America’s rising preterm birth rate. The review should ensure that all c-sections and inductions meet established American College of Obstetricians and Gynecologists (ACOG) guidelines regarding medical necessity of elective procedures.
“Even being born a few weeks early is a big problem for a baby,” said Lucky Jain, MD, MBA, Professor and Executive Vice Chair of Pediatrics and Medical Director, Emory Children’s Center, Emory University School of Medicine, Atlanta. “Prematurity is the leading cause of death among newborns, and those who survive are at greater risk for respiratory distress, delayed brain development, sudden infant death, jaundice, re-hospitalization and feeding problems.”
Many c-sections are medically necessary, said Laura E. Riley, MD, Medical Director of Labor & Delivery at Massachusetts General Hospital. “However, some doctors and patients may inadvertently be scheduling inductions or c-section deliveries early because of an inaccurate assessment of the due date,” Dr. Riley said.
An analysis published earlier this year by the March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) revealed an increase of nearly 60,000 preterm deliveries among single-birth pregnancies between 1996 and 2004, with more than nine out of 10 of those deliveries performed by c-section. Single-birth pregnancies increased by about 10 percent during this period, while c-section deliveries among women giving birth to just one baby increased by 36 percent.
Bryan T. Oshiro, MD, Associate Professor of Obstetrics & Gynecology and Medical Director of the Perinatal Institute at Loma Linda University Medical Center in Loma Linda, California, outlined a successful quality improvement program he is currently working on in Utah aimed at reducing the rate of inappropriate elective inductions of labor at less than 39 weeks of pregnancy. In this program, which consists of performance monitoring, peer review and patient education, elective inductions for pregnancies of less than 39 weeks decreased from an average of 27 percent of births to 5 percent of births.
The news on c-sections comes on the heels of the March of Dimes issuing a Petition for Preemies and its first annual state-by-state Premature Birth Report Card for Prematurity Awareness Month in November. The U.S. received a “D” on the Report Card when the March of Dimes compared actual preterm birth rates to the national Healthy People 2010 objective.
More than 540,000 babies – one out of eight – are born too soon each year in this country.
The March of Dimes is the leading organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies®, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.com or nacersano.org.
