Early deliveries plummet at hospitals with guiding principles

Early elective deliveries plunged 83 percent in one year at a group of hospitals that implemented policies guiding when labor should be induced or cesarean sections performed, a new study published in Obstetrics & Gynecology found.

The elective delivery rate for babies at 37 week to 38 weeks fell from almost 28 percent to less than 5 percent at the 26 participating community and academic hospitals, according to the study abstract. Admissions to neonatal intensive care units also fell, but not significantly, the researchers reported.

"This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life," lead author Bryan T. Oshiro, M.D., said Monday in an announcement from the March of Dimes, which helped fund the study.

Meanwhile, a study published last month in PLOS ONE found that a woman's choice of hospital plays a significant role in whether her baby is delivered by cesarean section.

Harvard School of Public Health researchers found C-section rates ranging from 14 percent to 38 percent among first-time mothers with full-term infants presenting for head-first births--generally considered a low-risk group. The average C-section rate was 27 percent.

"Even after taking into account factors that put women at risk of having a C-section, such as age and pre-existing health conditions, some hospitals still have higher rates of C-section delivery than others," senior study author S.V. Subramanian said in a statement.

The researchers did not examine what hospital practices and culture came into play, but cited previous studies suggesting variances including liability and insurance concerns, hospital teaching status, admission practices and use of midwives. Hospitals also may lack clinical guidance for when C-sections should be performed, they noted.

Another recent study, published in Health Affairs, found the rate of cesarean births varies from 7 percent to 70 percent at hospitals across the country.

To learn more:
- read the elective delivery study abstract
- here's the March of Dimes announcement
- check out the Harvard study and announcement

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