There has been a major effort in the past several years to reduce the rate of early elective deliveries. Those are births that for no medical reason are hastened by inducing labor or performing a cesarean section before the pregnancy has reached 39 weeks of gestation.
While those last few weeks in the oven may not seem like a big deal, groups including the March of Dimes and the American College of Obstetricians and Gynecologists warn that babies delivered even a few weeks before full term (39 to 40 weeks) can face short- and long-term health problems including feeding issues, breathing problems and developmental deficits.
It used to be that a woman who had reached 37 weeks had crossed the goal line. The goal line has moved.
Now, government data suggest those efforts are working.
The proportion of singleton births that were induced fell to 23.7 percent in 2011 and to 23.3 percent in 2012, after increasing for nearly 20 years and peaking at 23.8 percent in 2010, according to the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.
The stats cover women whose labor was induced for medical reasons, such as hypertension, as well as nonmedical reasons, like easier scheduling for the doctor or baby's parents, at all stages of gestation. But the report says the overall drop in induction rates may be fueled by doctors cutting down on their use of elective early induction as awareness of its potential hazards has spread.
Declines in induction rates between 35 and 38 weeks between 2006 and 2012 were "widespread by age, race and state," says Michelle Osterman, a statistician and author of the report. The biggest drop was in induction at 38 weeks, which dropped 16 percent over that time period.
Conventional wisdom used to be that babies born a few weeks early were "just little [full-]term babies," says Billie Short, chief of the division of neonatology at Children's National Health System in Washington, D.C. But as research documented problems — and extra costs — hospitals started pressuring doctors to change, she says.
Dr. Edward McCabe, chief medical officer at March of Dimes, says the data are part of a larger pattern suggesting a change in behavior on the part of doctors, moving early-term births to full term. A March survey of hospitals by the Leapfrog Group, a coalition of big employers that purchase health benefits, showed that the national rate of early elective deliveries fell to 4.6 percent last year.
"It used to be that a woman who had reached 37 weeks had crossed the goal line," says McCabe. "The goal line has moved."
It's important that women who have a real medical reason for delivering early aren't scared off from doing that, he says. But for everyone else, he advises giving the baby an "extra edge" of those last few weeks.
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