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Kylie McConville

Why Scheduling An Early Elective Delivery At 39 Weeks Is Risky For Baby

Hospitals are now banning moms-to-be from scheduling their births before 39 weeks — without medical reason — in an effort to discourage planned early deliveries.

The deputy medical director for the March of Dimes, Dr. Scott Berns, said that in the past, doctors were not against scheduled early deliveries, affirming that the scheduling wasn't a "problem" for them. Despite what other doctor's were saying, though, Berns helped put together a 'toolkit' that hospitals could use to discourage women experiencing healthy pregnancies from giving birth before 39 weeks.

The point of the study is to stop — and in the long run, to eventually ban — early elective delivery at or before 39 weeks because baby isn't fulling finished developing yet. Exceptions to the rule include medical emergency and medical concerns, but otherwise, moms who want to deliver early just because won't have that option anymore.

25 different hospitals agreed to participate in the study, which was published in the journal Obstetrics and Gynecology, to test the effectiveness of Berns' 'toolkit'. The purpose was to steer women and their doctors away from scheduling early inductions and C-sections if there was no health concerned involved. The 25 participating hospitals were picked from five different states — New York, Florida, Illinois, Texas and California, which account for 38% of U.S. births.

The 'toolkit' Berns helped develop included information about the latest statistics on the risks of early-term births — which doctors and nurses could read about, as well as details on fetal development. It was created by Berns, the March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health. The 'toolkit' also offered advice on how to implement the bans on early elective deliveries and also provided doctors with forms to help determine when a scheduled delivery might be necessary before 39 weeks.

Turns out, the 'toolkit' succeeded. Hospitals were able to cut back on the rate of early elective deliveries by 83%. From the success, researchers have set their sights on 100 more hospitals around the country, hoping to repeat the process with the same results. The purpose, they say, is to stop women from scheduling an elective delivery when there is no need.

Researchers are aiming to stop women from choosing elective surgeries as early as 37 weeks because even at 37 weeks, babies aren't finished fully developing in utero. Babies born between 37 and 39 weeks are still considered "early-term" babies, and they are at a higher risk for infection.

After banning elective surgery at 39 weeks, the five participating hospitals reduced elective early term deliveries from 28% in January of 2011 to less than 5% in December of 2011. Of the shocking decline, Berns said, "That's a realitively short period of time to show significant change. It's really cool because we were able to show we could do this across a diverse set of hospitals in multiple states."

But it's not to say the process went off without a hitch. Doctors and nurses at the various hospitals participating in the study engaged in regular phone calls to troubleshoot problems and share strategies. Some even noted that physicians — and moms-to-be — resisted the new policies. But Berns stands by the effectiveness of educating both doctor and patient about the risks involved in elective early delivery without medical need. He said, "If you show a mom that these last weeks of pregnancy really count, that the chances for a baby to be born healthy are higher if she waits it out a couple more weeks, that really resonates."

Would you ever have an early elective delivery without medical need?

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