On June 12, the Tennessee Hospital Association reported in a news release that early elective deliveries — deliveries less than 39 weeks — had reduced in state hospitals by 75 percent in seven months, with 59 Tennessee hospitals committed to reducing their number. Local hospitals participating in the initiative include Franklin Woods Community Hospital, Indian Path Medical Center, Johnson City Medical Center, Holston Valley Medical Center and Bristol Regional Medical Center.
Nurse Manager Marsha Rodgers and Assistant Nurse Manager Hannah Baker from the Family Birth Center at JCMC said they’ve worked with the Tennessee Initiative Perinatal Quality Careprogram for about two years now and explained that the push for mothers to wait out the full 40 weeks is important because of the many consequences that arise with infants who are delivered too early.
Rodgers and Baker said complications such as brain development issues, feeding problems, jaundice, diabetes, heart disease, high blood pressure and hospitalization into neonatal intensive care units have all been recorded consequences of elective births.
An article on Health4Mom.org said babies who are born before 37 weeks are six times more likely than full-term infants to die in the first week of life, three times more likely to die in the first year of life and two times more likely to be readmitted to the hospital.
“Thirty-seven weeks is considered term, but just because you’re (at) term doesn’t mean you need to be delivered,” Rodgers said. “Basically, you don’t want patients delivering before 39 weeks electively. Now, spontaneous labor is fine. If it’s a medical indication, it’s fine, but ... not to induce labor electively just because we want to.”
Rodgers said toward the end of a pregnancy, mothers tend to get tired and increasingly uncomfortable and said she’s seen the full spectrum of mothers’ wishes when it comes to delivery time.
“You have some that are very educated, who know that it’s best to wait and who do not want an induction for any reason at all and kind of have to be talked into it at 41 weeks. Then you see others who think it’s their choice,” she said.
“It’s a cultural change for everyone, for the public and ... it takes awhile to get the public educated on why we need to do these things. We have provided lots of education to the offices for their prenatal packets and we’ve been doing that for a while. We started on this a couple of years ago and we actually have an interdisciplinary team ... and we include our physicians in this. We got our physicians involved. They have been very much on board.”
Rodgers said insurance reimbursements in certain states could potentially be lost to those who choose to have an early elective delivery.
“We listened to a webinar the other day from the state of South Carolina and they are going toward Medicaid and commercial insurers (that) will not reimburse for an elective delivery less than 39 weeks. If there’s no medical indication, they will not reimburse,” she said. “I’m sure that that will be a trend. We as a hospital have not initiated that, of course. The 39-week initiative is a perinatal core measure ... from (Centers for Medicare and Medicaid). They have set the goal for hospitals to not induce less than 39 weeks.”
Rodgers said the goal right now is to have no more than 5 percent of pregnancies induced statewide, and so far the Family Birth Center is following suit.
“Since May of 2012 we’ve really only had two that ... did not meet the criteria, so I think that’s really, really good in a year,” she said. “We believe in the patient being a very important part of their health care process. The thing of it is, it’s ... lifelong effects. It’s not just the effects of the hospitalization, but it could affect this baby lifelong and that’s what you don’t want. Labor is a natural process and we need to, as much as possible, let it happen spontaneously, naturally and without intervention.”
For more information, visit www.healthytennesseebabies.com or Healthy Tennessee Babies Are Worth The Wait on Facebook.