Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries -- those without a medical cause for doing so -- dropped from about 28 percent to just under 5 percent.
"What everyone is amazed about is we did it in a year," said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.
The findings from the study were published this week in Obstetrics and Gynecology. For more than 30 years, the American College of Obstetricians and Gynecologists has recommended that women and their doctors wait until at least 39 weeks of gestation to deliver a baby. Delivering earlier is associated with health complications for the babies, including breathing and developmental problems.
Slippery Slope With Early Deliveries
But a "slippery slope" had developed around early elective deliveries, says Dr. Elliott Main, a high-risk obstetrician and director of obstetrics quality at Sutter Health. "Your due date was 40 weeks, and then we thought 39 was just as good. Then it became 38 and a half, then 38, and that's the slippery slope."
Over the last several years, though, some major studies were published, Main said, that drove home the problems around early deliveries, including one that showed developmental problems associated with early delivery can persist into elementary school. "That was a wake up call," Main says. "That made us say, 'OK, we really should retrench. We should pull back and not deliver these babies before 39 weeks."
Main is a lead author of the protocol used by hospitals in the study. Main called California a leader in reducing early elective deliveries, saying several major health systems in the state -- including Sutter Health, Kaiser and Dignity Health -- have "all seen impressive results, down in the 1-3 percent overall for these early elective deliveries."
At present, Main says, a baby is considered to be at term from 37 to 41 weeks. But he said there may be different gradations of term and said obstetrics may be leaning toward new profiles, such as early term, full term and post term to "reinforce that there are differences without notions of term."
The study found there were no ill health effects for the mothers. In addition to California, a range of hospitals in Florida, Illinois, New York and Texas participated in the study. The five states were chosen because they account for almost 40 percent of all births in the U.S.
The five participating hospitals in California were El Centro Regional Medical Center, Mission Hospital, Mills-Peninsula Health Services, Sutter Roseville Medical Center, Sutter Medical Center Sacramento, San Gorgonio Memorial Hospital.