Preventing unnecessary cesarean sections and inductions can lead to fewer preterm births, healthier babies, and lower health care costs, agreed experts who participated in the March of Dimes Symposium on Quality Improvement to Prevent Prematurity. The group encouraged health care systems to implement protocols, checklists and review procedures as part of quality improvement in perinatal care.
“Consumers can get a better assessment of the quality of an HDTV or a dishwasher than they can of a hospital’s perinatal care,” said Carolyn M. Clancy, MD, director, Agency for Healthcare Research and Quality, at the symposium.
Women should talk with their health care provider about why an induction or c-section might be necessary and the health risk if her baby is born too soon. If a woman has a choice, and is planning to schedule her baby’s birth, she should wait until at least 39 weeks, the March of Dimes says.
“Hospitals and health care systems can help prevent preterm births by addressing elective deliveries prior to 39 weeks that are not medically necessary, which may result in c-sections and impact neonatal morbidity and mortality. The Joint Commission’s voluntary Perinatal Care Core measures are based on scientific evidence and can help organizations enhance quality and avoid bad outcomes,” said Mark R. Chassin, MD, FACP, MPP, MPH, president of The Joint Commission.
Tennessee-based Hospital Corporation of America, which delivers about 5 percent of all U.S. births in the 21 states it serves, reduced the primary c-section rate, lowered the rate of maternal and fetal injuries, and reduced the cost of obstetric malpractice claims by 500 percent, through simple quality improvement strategies.
At Geisinger Health System in Pennsylvania, modern information management systems ensure that all pregnant women are screened for chronic conditions that can be treated to help lower the risk of preterm birth. The aim is to improve the overall health of mothers-to-be and minimize complications by standardizing the pregnancy care process.
Participants also discussed changing the definition of a full-term pregnancy to 39 to 41 weeks from the present definition of 37-41 weeks. “We know that every week of pregnancy counts,” said Alan R. Fleischman, MD, March of Dimes medical director. “A new standard for pregnancy length could help prevent preterm births by changing the expectations of patients and health care providers alike.”
In the United States, more than 540,000 babies are born too soon each year. Preterm birth costs the United States more than $26 billion annually, according to the Institute of Medicine. It is the leading cause of newborn death, and babies who survive an early birth often face the risk of lifetime health challenges, including breathing problems, cerebral palsy, mental retardation and others. An October March of Dimes report found that 13 million babies worldwide were born preterm, and more than one million die each year.
November is Prematurity Awareness Month®, a time when the March of Dimes focuses the nation’s attention on the growing problem of premature birth (birth before 37 weeks gestation). More information is available at marchofdimes.org/fightforpreemies.