Baystate Working with Moms-to-be to Reduce Pre-term Births

SPRINGFIELD — The report card is in on premature births, and the grades are far from glowing. The March of Dimes released its 2012 Premature Birth Report Card in November, and while the U.S. pre-term birth rate dropped for the fifth consecutive year in 2011 to 11.7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} — the lowest in a decade — the country still earned a disappointing ’C’ grade.

The March of Dimes grades states by comparing their rate of premature births to their 2020 goal of 9.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. Three states and Puerto Rico earned an ’F,’ and only four states — Maine, New Hampshire, Oregon, and Vermont — were graded an ’A.’ Twenty-two states, including Massachusetts, received a ’B’ grade and are one step away from achieving the goal. Still, “we still have a long way to go,” said Dr. Glenn Markenson, chief of Maternal Fetal Medicine at Baystate Medical Center.

More than 500,000 infants are born prematurely in the U.S. each year, and about 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all deliveries are scheduled before 39 weeks, according to the U.S. Department of Health and Human Services. Furthermore, a recent study by the Leapfrog Group, a hospital-quality watchdog, shows that U.S. hospitals vary widely in their rates of elective pre-term deliveries, ranging from less than 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to more than 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

“Early deliveries should only be an option for medical reasons, when the life or health of mother or baby is in jeopardy,” said Markenson. Under his leadership, Baystate Medical Center has been working to establish strong guidelines to prevent unnecessary pre-term deliveries by induction or cesarean section, and last year the hospital instituted a ’hard stop’ for any non-medically required elective delivery prior to 39 weeks, and all elective inductions in first-time mothers.

Markenson said the practice of elective pre-term birth finally caught many healthcare-quality officials’ attention when more and more studies began to be published showing its potential harm, including a recent March of Dimes report showing that babies born in the 37th or 38th week have a higher risk of dying in their first year than a baby born after 39 weeks. Fetal development is not complete until 39 weeks, and a baby’s brain and lungs are still growing in the last weeks of pregnancy. As a result, babies born just a few weeks early are more likely to develop breathing problems, cerebral palsy, intellectual and developmental disabilities, or other health challenges. In addition to these life-changing or even life-threatening challenges, early deliveries prior to 37 weeks cost the already-financially strained U.S. healthcare system more than $26 billion each year, according to the Centers for Disease Control and Prevention.

In addition to working with other Massachusetts hospitals to help the state achieve an ’A’ grade in the March of Dimes rankings, Baystate is helping lead a statewide initiative called the Massachusetts Perinatal Quality Collaborative. More than 100 representatives from the state’s 47 birthing hospitals have been studying ways to standardize and improve maternity care throughout Massachusetts. And the group has made it a priority to focus on reducing early elective deliveries.

“We have been carefully looking at early elective deliveries for the past couple of years at the hospital,” said Dr. Andrew Healy, medical director of Obstetrics at Baystate Medical Center. “In fact, we began seeing a decrease in the number of early-term babies (37-38 weeks) being admitted to our Davis Neonatal Intensive Care Unit for complications even before introducing a formal policy with a hard stop.”

Molly Gray, director of Baystate Children’s Hospital and Women’s Services, also confirmed that the hospital is seeing fewer admissions to its NICU, which she attributed directly to the facility’s new policy and efforts to educate caregivers and families alike.

“Our nurses have been very involved in this important team effort to reduce the number of pre-term births at Baystate and are working closely to help families understand that our new policy is in their best interest, especially for their baby,” she said. “We understand that people live very complicated lives today and feel the need to schedule everything, but some things, such as childbirth — a natural physiological process — are best left unscheduled.”

According to Markenson, some obstetricians and gynecologists became complacent before the new efforts got underway, with their skill in successful inductions and cesareans. “For women asking, it was simply a matter of convenience, such as wanting relief from the discomforts of pregnancy during a hot summer. And it became convenient for physicians, too, who might have been going on vacation and wanted to fit the birth in before leaving,” he said.

Healy said he and his fellow providers recognize the importance of communication with moms-to-be about the Baystate policy, the reasons it exists, and its benefits for babies. “We encourage providers to discuss the policy up front with their pregnant patients, so that they are aware of it and there won’t be any unnecessary stress at 37 weeks if a woman is uncomfortable and requesting delivery.”