Reminds us of dangers associated with delivering a baby electively before 39 weeks of gestation
September is National Infant Mortality Awareness Month, providing an ideal time for families in Arizona and nationwide to think about the health of expectant mothers and babies, while also raising awareness about how to increase the likelihood of a safe and healthy pregnancy and delivery.
In Arizona the infant mortality rate is 6.6 per thousand live births, ranking the state No. 22 nationwide, according the 2010 America's Heath Rankings from the UnitedHealth Foundation.
Access to appropriate prenatal and postnatal care is critically important for the health of both mothers and babies. It is also important for mothers, families and physicians to recognize the dangers associated with elective deliveries before 39 weeks of gestation and the potential impact on infant morbidity. The potential complications involved with elective childbirth before 39 weeks are very real, yet many first-time mothers may be unaware of the risks.
Babies born before 39 weeks are also more likely to have breathing problems and developmental delays, according to numerous published studies. A review of claims data by UnitedHealthcare showed that 48 percent of newborns admitted to the neonatal intensive care unit (NICU) at select hospitals were from scheduled admissions for delivery - many before 39 weeks of gestation.
After sharing these findings, physicians and hospitals in the program altered practice patterns and realized a 46-percent decrease in NICU admissions in the first three months - a decline that has held stable.
Yet, a majority of first-time mothers are unaware of the risks associated with early deliveries. According to a national survey released in 2009, more than 90 percent of first-time mothers believe it's safe to deliver a baby before 39 weeks of gestation.
In addition, nearly one in four respondents considered a baby to be full-term at 34 to 36 weeks, even though the American College of Obstetricians and Gynecologists (ACOG) defines full term as 37 weeks and advises against elective deliveries before 39 weeks.
The purpose of the survey, commissioned by UnitedHealthcare, was to gauge women's understanding of full-term pregnancy and the gestational age at which it's safe to deliver a healthy baby. The survey queried 650 insured, first-time mothers from varied geographic, ethnic and socioeconomic backgrounds.
The study findings underscore how important education is to improve health and well-being. Other studies have already shown that efforts to educate physicians make a positive impact in helping to reduce the rate of elective deliveries.
We should also consider similar outreach among women to help stem the rise in such deliveries.
The reason for concern is simple: As the number of pre-term and early-term births has increased, there also have been increases in health risks for early-term infants, many of whom require extended hospital stays. Parents suffer as well, missing out on important bonding time with their newborns, and some even experience depression.
In addition, it is important to note a report issued in January by The Leap Frog Group revealed tremendous variation among hospitals when it comes to early elective C-sections and elective inductions, with some facilities performing those procedures 10 times more frequently than others.
The practices of 773 hospitals nationwide were examined, including those in Arizona. The full report is available at www.leapfroggroup.org/tooearlydeliveries.
The decision to induce labor early or perform a C-section before a pregnancy is full term should take clinical recommendations into account and reflect the baby's and mother's health and medical needs, not convenience.
To be sure, the last few weeks of pregnancy for many mothers can seem endless and often uncomfortable. But expectant parents should take the opportunity to learn just how important the last few remaining weeks are for their baby's development and health.
More information about how to have a healthy pregnancy is available at www.healthy-pregnancy.com.
• Dr. Robert Beauchamp is senior medical director at UnitedHealthcare of Arizona.