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New Pregnancy Guidelines lower C-Section Rates

Posted by on Jan. 3, 2010 at 4:54 PM
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Annette Delk had to have a cesarean section after she labored for 18 hours with no progress during the birth of her first child.

Although she had always wanted a natural birth, she continued to have C-sections for two other children and will have another when she delivers her fourth child, a boy, at Centennial Hospital in March.

But along the way, Delk and her doctor agreed to follow one very important rule: No elective, scheduled C-section would be done before 39 weeks of pregnancy.

Centennial Hospital and other HCA hospitals nationwide have limited elective deliveries — by induction or C-section — to 39 weeks and later since 2007, under a perinatal safety initiative. Studies have shown that infants have a greater chance of spending their first days of life in the neonatal intensive care unit if delivered too soon because their brain and lungs may not be fully developed. The push for later elective deliveries had come after doctors were seeing too many women schedule their births between 34 and 36 weeks for convenience reasons.

"The objective is to have more healthy babies in Tennessee," said Dr. John Wilters, chairman of obstetrics and gynecology at The Women's Hospital at Centennial. "It's scary for a new mom to go up to the NICU. We want to prevent putting them in that situation."

HCA, a Nashville-based hospital company that handles about 5 percent of the nation's births each year, has seen drops in C-section rates, declines in premature births and low birth rates, and fewer birthing injuries to mother and baby since the plan was put in place. March of Dimes recognized HCA's efforts as a model of safe practices at a national conference in October.

More hospitals, including Baptist Hospital and Vanderbilt in Nashville, strive to get women to the 39-week point for elective deliveries. Medical reasons can pre-empt that rule, and the decision is sometimes best made by doctor and patient.

HCA's C-section rate has dropped between 10 percent and 15 percent, and NICU admissions have decreased 16 percent, said Dr. Steven Clark, HCA's medical director of women's and newborns' services.

The "initiatives have led to a dramatic reduction in bad outcomes," Clark said. "But more importantly, there is clear evidence these initiatives have improved the care for countless mothers and babies."

Methods standardized

Hospitals that fall under HCA, including TriStar Health System and Centennial Hospital, also follow the same birthing procedures and rules in a streamlined plan that every nurse and doctor adheres to when delivering a baby. The checklist protocol includes everything from training for doctors and nurses, to reading fetal heart monitors the same way, to ensuring all doctors use the same methods to deliver a baby whose shoulders get stuck during the birth process.

For Delk, 32, knowing exactly what to expect every time she has a baby is important. She gets anxious and emotional about her C-sections.

"Every little step and procedure, even being as nervous as I am, they are very thorough and good at explaining what's next," Delk said.

Joann Ettien, administrator of The Women's Hospital at Centennial, said standardization is important to the safety initiative.

"If you take away the surprise, you take out the element of risk," she said. "Every woman who comes in has a care path, a checklist of items that also takes the human error out of the equation."

The American College of Obstetrics and Gynecology, a widely respected national membership organization, has been calling for more hospitals across the country to pay attention to the 39-week-and-greater rule for elective deliveries.

At a March of Dimes conference, HCA health officials spoke about their success and why they began the safety initiative to reduce elective deliveries: "As a profession, we have become sloppy and regularly violate the standard of care set by our professional organization."

A recent March of Dimes report card revealed that the national premature birth rate was about 12 percent, above the national 2010 health goals of 7 percent. Tennessee got an "F" on the report card for a 14.2 percent premature birth rate.

Tamara Currin, associate director of program services for March of Dimes, said some women were choosing to do elective births between 34 and 36 weeks, and doctors allowed it because the babies weighed enough. The lungs and brain were not often developed enough.

"Our minds often equate healthy and big," Currin said. "Just because a baby is healthy in size doesn't mean they are healthy. We now know that babies born pre-term are often sicker than a baby born later."

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by on Jan. 3, 2010 at 4:54 PM
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