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Sat, 20 Nov 2010 00:01:08 -0800
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They still have a long way to go.  What's wrong with leaving the baby alone
to 42 weeks and beyond?  But it's a start.  Gloria

 

Minn. tells the stork: Take your time
JEREMY OLSON, Star Tribune

Minnesota might become the first state in the nation to create a policy
against a common practice in obstetrics: inducing childbirth early just for
the convenience of doctors or mothers.

Mindful of research showing health problems with babies delivered early, the
state Department of Human Services has proposed that hospitals create plans
by 2012 for reducing elective inductions prior to 39 weeks gestation. The
penalty for those without plans? Fill out onerous paperwork for every
state-funded delivery.

The policy would sync with a campaign by the March of Dimes to encourage
women to carry their pregnancies the full 40 weeks whenever possible.

"Just because we have the tools [to induce labor] doesn't mean we should be
using them," said Marianne Keuhn of the Minnesota chapter of March of Dimes,
an advocacy group that promotes healthy babies and pregnancies.

While 37 weeks gestation is considered full term, research has shown higher
rates of respiratory problems, longer hospital stays and intensive care for
babies born before 39 weeks. Induced labor before 39 weeks also increases
the rate of emergency C-section deliveries.

The rate of induced labor has tripled in the United States since 1990.
Roughly one in five deliveries in Minnesota are now medically induced, often
with the intravenous drug Pitocin. The state does not know how many are
elective and how many are necessary, but the proposed policy would require
hospitals to report induced deliveries and the reasons.

Some women seek inductions to end what seem like interminable third
trimesters. A few want to avoid deliveries on Halloween -- or certain Zodiac
signs for their children, said Dr. Stan Davis, medical director of
simulation and teamwork for Fairview Health Services.

"I'm all for consumerism," Davis said. "But when it creates a problem like
this, it's not good."

The policy would not limit inductions for medical reasons or conditions that
make continuing a pregnancy risky. Its target is deliveries that are
scheduled early to suit doctors' vacation schedules, or when expecting
mothers know relatives will be in town to help with their newborns.

The specter of more paperwork should suffice to motivate doctors and
hospital administrators, said Dr. Jeff Schiff, medical director of the Human
Services Department. Officials opted against a more heavy-handed idea:
denying state payment for elective inductions prior to 39 weeks. Medicaid,
known in Minnesota as Medical Assistance, pays for 38 percent of births in
the state.

"No one is losing money. That's not the goal here," Schiff said. "The goal
is to use our policies to ... encourage what everybody knows to be good
medical practice."

Schiff will discuss the policy Nov. 17 with doctors, hospital leaders and
insurers as a first step toward making it official. Keuhn said Minnesota
could be the first state with a policy solution, though Hawaii, New Jersey,
Oklahoma and other states are confronting elective inductions, as well.

Changes at Fairview

Fairview was an early leader on the issue in 2008, when it formally
discouraged early elective inductions at its metro-area hospitals.

Since then, Fairview's rate of elective inductions has dropped below 1
percent. Birth complications have dipped, as well. The average APGAR score
-- a 10-point rating of newborn health -- increased from 4.8 to 5.5 for
babies born in Fairview hospitals.

Davis said there is growing momentum against early elective inductions. The
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the
national body that accredits hospitals, just added induction rates as one
option for hospitals to track to gain accreditation. "This has been a
growing practice," said Ann Watt, an associate director of quality
measurement for JCAHO. "I think, because of its growing prevalence, people
were able to see the negative effects."

At week 38 of her pregnancy, Gina Jacobsen is anxious to give birth to her
second daughter. Inducing labor, though, wasn't a thought for the West St.
Paul woman.

"She can come whenever she wants," Jacobsen said, "as long as she comes
soon!"

Stephanie Dickinson is only at week 28 of her pregnancy, but the sonographer
at Allina's obstetrics clinic in Eagan is thinking about scheduling her
delivery. Then she could arrange child care for her kids at home while she
recovers.

Of course, the deliveries of her other children were both early, she said.
"If I make it to 38, I will ask."

Hospitals vary

Minnesota hospitals vary widely in their induction rates, according to data
from the Department of Health. Eight percent of the 4,138 babies born at
Abbott Northwestern Hospital in Minneapolis were induced in 2009, and only 2
percent were induced prior to 39 weeks gestation. By comparison, 38 percent
of the 590 births at New River Medical Center in Monticello, Minn., were
induced, and 10 percent were induced before 39 weeks.

But scheduling a delivery isn't always about convenience, especially at
smaller, rural hospitals. Some schedule deliveries during the day, when they
have anesthesiologists and other specialists on hand to handle
complications. Inducing labor might also be preferable for mothers who live
miles away.

The highest reported rate was at First Care Medical Services in Fosston,
Minn., where 64 of 78 deliveries were induced, and 29 inductions took place
prior to 39 weeks. Chief executive Patricia Wangler said the data is
incorrect, probably because of a new records system. While the hospital
serves a remote region of northwest Minnesota, Wangler said it is "rare" for
her doctors to schedule deliveries just because patients live far away.

Schiff said the key to progress will be broad participation by hospitals and
consistent information for mothers.

"Then everyone will get the same message," he said, "that convenience is
less important than the health of the babies."

Jeremy Olson . 612-673-7744


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