Why Maryland hospitals are saying ‘no’ to mothers who want early deliveries

The number of babies delivered early in Maryland hospitals because their parents or doctor elected to induce for convenience rather than a medical reason hit a landmark recently.

Zero.

In December, the most recent month for which data is available, Maryland hospitals recorded zero early-elective deliveries before 39 weeks and came close to no elective caesarean sections before full gestation, according to the Maryland Patient Safety Center. The center and the Maryland Hospital Association had called late last year for hospitals to stop early-elective deliveries before 39 weeks.

“It’s so much safer for infants,” said Dr. Ann Burke, medical director of obstetrics and gynecology at Holy Cross Hospital. “Elective deliveries prior to 39 weeks gestational age are linked to increased complications for both mother and baby.”

The American Academy of Family Physicians says early-elective deliveries double the caesarean delivery rate and increase instances of breathing and feeding problems.

A study published in the American Journal of Obstetrics & Gynecology found that more than 10 percent of deliveries in the U.S. before 39 weeks were believed to be by choice. The study found that “hard stop” hospital policies preventing non-medical elections were most successful. 

To be fair, there are a number of reasons why parents or doctors may choose to induce labor early, said Maryland Patient Safety Center President Robert Imhoff. At some hospitals, for example, physician availability may be limited. The family may also have scheduling issues, he said. 

“A great example is a father was being deployed to Iraq and wanted to see his baby born before he left,” he said.

But even when there are legitimate reasons to consider, the center supports hospitals refusing early-elective deliveries to reduce risk to babies, Imhoff said.

The effort is part of a broader  push at Maryland hospitals for increased safety and cost savings as part of the state’s Medicare waiver. The  waiver, granted to the state earlier this year, allows Maryland to set the rates for hospital services. Maryland hospitals agreed to find $330 million in savings for Medicare as part of a new waiver agreement, which began earlier this year. If they do not hit certain cost-saving and quality measurements, the state will lose its waiver.


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