A new initiative spreads awareness about the benefits of taking pregnancies to full term.
Louisiana is second in the nation for the highest number of premature babies. While the March of Dimes sets their goal below 8.1 percent preemie births, Louisiana holds a 12.3 percent prematurity rate, many of those a result of elective inductions.
Elective deliveries before 39-weeks gestational age carry significant risks for the baby with no known benefits to the mother. Some sobering statistics:
- The rate of labor induction in the United States has more than doubled since 1990.
- In 2006, more than 22 percent of all pregnant women had their labor induced.
- As many as 15 percent of all early inductions in our country could be termed not medically indicated.
Higher pre-term birth leads to higher likelihood for trouble, says Touro OB/GYN Jennifer Laguaite, M.D. “We’ve come to realize early term delivery can lead to serious complications for the newborn,” she says.
Problems that include:
- Respiratory issues
- Low birth-weight
- Trouble maintaining body temperature
- Complications with breastfeeding
- Higher potential for jaundice
- Higher NICU admissions
- Higher infant death rate
The good news, Dr. Laguaite says, is that with the help of a March of Dimes 39+ Weeks Quality Improvement Initiative, those numbers are coming down. “We’re seeing a lot less scheduled inductions,” she says. “Prior to the initiative, I don’t think we were led clearly about what gestational age to induce safely. Sometimes they were being done just to ease the discomfort of pregnancy or to know when the baby is coming. Now that we see clear benefits to going further with the pregnancy, we can counsel our patients on it. It gives us a milestone.”
A year-long, five-state study showed that in hospitals participating in the initiative, the rate of elective early term deliveries went from 27.8 percent to 4.8 percent, an enormous 83 percent decline. That saves families, insurers and taxpayers money; saves parents the emotional toll of a sick baby; and most importantly, saves lives. “When we tell patients in those terms, they understand how important it is for the baby to get more mature and be ready for birth,” she says.
Patient education has been key, Dr. Laguaite says, because the more parents-to-be hear the information about delaying induction, the better they understand the benefits. In addition, they get more information on what to do to have a happier and healthier pregnancy, all of which can contribute to a delivery at full term. Dr. Laguaite, her partners and Touro’s childbirth classes touch on topics like:
- Healthy eating habits
- Starting or maintaining exercise safely
- Appropriate caloric needs for baby and weight gain through each trimester
- Avoiding high blood pressure and gestational diabetes
Even better, Dr. Laguaite says, is to see the doctor before conceiving a baby.
“I love pre-conception counseling visits,” she says. “It’s so much better when a mother has pre-existing conditions if I can review the risks and her medications and show her how to optimize her condition during pregnancy. If a woman understands what’s involved in medical care during pregnancy … if they know the system before they are even pregnant, all these things are so much better controlled, and I find we can more likely get the baby to a safer gestational age.”
Medically valid reasons for induction might include:
- Chronic or gestational diabetes
- High blood pressure
- Poor fetal growth rate
- Low fluid around the baby
But even those patients can work to maintain their pregnancy as long as possible, and doctors are scheduling their inductions more conservatively, Dr. Laguaite says. One of the more successful births she can remember was a mother with insulin-resistant diabetes and hypertension risk. The mother was diligent in her care and followed everything Dr. Laguaite asked of her, so, even though the baby was born at 36 weeks, it was in the NICU just a short time and everything worked out well.
“I really celebrated her at delivery,” she says. “I know for a fact that a lot of women in her condition would have delivered at 32 weeks. She brought herself out to 36 weeks and her baby was better for it.”
Dr. Laguaite feels privileged to work with a practice making a difference in the New Orleans birth community. “My group is very supportive of this initiative, and Touro as a whole is very supportive. We’re tracking inductions and why and at what gestational age, and really doing all we can to limit pre-term deliveries and provide safer care to our patients and their babies.”