published Monday, March 17th, 2014

Labor delay: Hospitals put brakes on early deliveries for moms' and babies' sakes

Josie Holmun holds her son, Cooper, on the day after his birth at Parkridge East Hospital in East Ridge.
Josie Holmun holds her son, Cooper, on the day after his birth at Parkridge East Hospital in East Ridge.
Photo by Doug Strickland.
  • photo
    Newborn Cooper Holmun is held by his mother, Josie Holmun. Area hospitals are cutting sharply back on early deliveries through induced labor or caesarean sections, allowing babies to mature for longer before birth.
    Photo by Doug Strickland.
    enlarge photo

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    Josie Holmun holds her newborn, Cooper Holmun, on Friday, not quite one day after his birth, at Parkridge East Hospital in East Ridge. Holmun went into labor the night before she was scheduled to be induced, she said.
    Photo by Doug Strickland.
    enlarge photo

DRAMATIC DROPS

Hospitals across Tennessee and the nation have seen major drops in their early elective deliveries. These numbers for elective deliveries deliveries include all that occurred between 37 and 39 weeks' gestation except those that are medically justifiable. The target is 5 percent.

Erlanger Baroness Hospital

2012 -- 42.8 percent

2013 -- 24 percent*

Erlanger East Hospital

2012 -- 52.9 percent

2013 -- 32 percent*

Parkridge East Hospital

2012 -- 42.8 percent

2013 -- 5 percent

* Erlanger officials and Tennessee Hospital Association say the hospital's rate has consistently fallen below 8 percent in the last six months.

Source: The Leapfrog Group

When Bridget Hayes started her nursing career in the 1980s, mothers came to the hospital to give birth only when their babies were ready.

Over the next two decades, she saw a shift. Induced labor and cesarean sections for non-medical reasons became common. Planned deliveries made doctors' schedules less erratic. Patients wanted to have their babies when their families were in town.

"In the '90s it become all about convenience and schedules," Hayes said. "Patients started becoming more empowered in their care, and pushing doctors to induce on a date that worked best."

But now the pendulum is swinging -- dramatically -- in the other direction, said Hayes, now director of labor and delivery services at Parkridge East Hospital.

Parkridge and other hospitals have imposed firm new policies to make sure mothers and doctors allow babies to develop until week 39 and avoid early elective deliveries, as scheduled procedures which are not medically justified are called.

Within two years, early elective delivery rates at Parkridge, Erlanger Health System and other Tennessee hospitals have plummeted as growing research showed they are risky for mother and baby.

In May 2012, nearly 16 percent of all Tennessee babies delivered earlier than 39 weeks of gestation were considered elective births.

Today, that number is below 5 percent, said Chris Clarke, senior vice president for the Tennessee Hospital Association.

"It's extremely impressive for us to see that kind of drop in a year," she said.

Georgia also reduced its rate from 10 to 3 percent within the year.

The trend follows a national decline that health experts say is remarkable in its scale and speed.

For the first time in 2013, the national rate of elective deliveries hit the target rate of less than 5 percent of all early deliveries, reported The Leapfrog Group, a national nonprofit that has publicized the data since 2010.

Significant brain development occurs in the womb between 37 and 40 weeks. Babies born even one or two weeks earlier are at greater risk for respiratory problems, feeding issues and other complications.

Groups like the March of Dimes and the American College of Obstetricians have preached for years on the problems with scheduled early deliveries.

But the recent push to end the practice is a testament to public monitoring, said Erica Mobley, senior communications manager for Leapfrog.

"Until we started reporting rates by hospital, no one knew how bad the problem was," Mobley said. "Many hospitals said they had never tracked those numbers before."

One of those was Erlanger.

"For a few years we didn't fully know how important it was," said Traci Josephsen, women's service line administrator at Erlanger.

Since then, organizations statewide made dropping that rate a priority, including the Tennessee Hospital Association, which developed a campaign called "Healthy Tennessee Babies are Worth the Wait."

Creating a "hard stop" -- not just an advisory -- has made all the difference, said Clarke.

"The tipping point came with a lot of physician leadership saying, 'We need to throw down the gauntlet and change this,'" she said. "'And we need hospitals to hold us accountable.'"

In most cases, the hard stop is a form that doctors must fill out before a baby can be delivered early. The form lists medical conditions such as diabetes or fetal malformation as valid reasons for the procedure.

Parkridge adopted its policy in the fall of 2012, and it made all the difference, Hayes said. In one year, Parkridge's rate of early elective deliveries fell from 42 percent to the Leapfrog target rate of 5 percent.

"We'd been leaning toward it for years, but we started seeing the change immediately when we put that hard stop in," she said.

Doctors' found the new policy a "bit painful at first," Hayes said, but everyone has adapted.

"I've heard the physicians say that it actually relieves them of the burden of that decision. They have the medical conditions in front of them to show the mother."

A rigid policy, instituted last year, is also the key reason for Erlanger's steep decline, Josephsen said.

These days, physicans wanting to schedule a delivery must go through an administrator. If the doctor's reason for the procedure doesn't match a condition on that list, she tells them no.

In December 2012, 33 percent of Erlanger's early deliveries were elective. For December 2013, that number was zero. Last week, the Tennessee Hospital Association recognized the hospital for its "leadership in reducing the number of babies born electively."

Mothers are also adapting well to what Josephsen called a "culture change."

"You still have that miserable patient who asks [to schedule a delivery]," said Josephsen. "The difference now is that it's not routine."

Contact staff writer Kate Harrison at kharrison @timesfreepress.com or 423-757-6673.

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