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March of Dimes project curbs early delivery of babies at St. Joseph's Hospital

TAMPA — For decades, obstetricians were advised not to schedule deliveries unnecessarily early, since the final weeks of pregnancy are so critical to the development of babies' brains and lungs. But the practice became increasingly popular, largely out of convenience to mother and doctor.

That's no longer the case at St. Joseph's Women's Hospital in Tampa, which is part of a national project by the March of Dimes to curb elective early-term deliveries.

Encouraged by the project's results, other Florida hospitals, including Bayfront Medical Center and Tampa General Hospital, are now embracing similar policies.

"Every week matters," said Dr. William Sappenfield, director of the Chiles Center for Healthy Mothers and Babies at the University of South Florida. "If you need to be delivered early, it is much safer now than it has ever been — but that doesn't mean it is as safe to deliver early as it is to be full term."

Sappenfield is one of the lead authors of a study involving St. Joseph's and nearly two dozen other U.S. hospitals, released Monday in the medical journal Obstetrics & Gynecology.

The project targeted deliveries that weren't medically necessary during the 37th and 38th weeks of fetal gestation. While not considered premature, babies born in this time frame may not be fully developed. Called "early term," they face greater risks of many problems, including cerebral palsy and learning disabilities.

Experts now consider a baby full term after 39 to 41 weeks, although advances in neonatal care have allowed many to survive if born much earlier.

When the project launched at St. Joseph's in 2011, officials found that 39 percent of their early term deliveries were being done for convenience, not medical necessity.

The consequences could be seen in St. Joseph's neonatal intensive care unit. In a typical month, it admitted 11 early term babies — who looked fine at delivery — for feeding or breathing problems, or unstable body temperatures.

In 2007, the March of Dimes launched a campaign aimed at reducing the problem in the five largest states. California, Florida, Illinois, New York and Texas together account for almost 40 percent of U.S. births.

St. Joseph's, which runs the busiest maternity unit in Tampa Bay and the second-busiest in the state, joined the national study and rolled out strict new policies.

"It's not about your vacation. It's not about when your mother or mother-in-law will be coming down," said Karen Howell, director of patient care services at St. Joseph's Women's. "It's really about what's best for the baby."

The key to changing the culture, she said, was a "hard stop" preventing the scheduling of an elective early term delivery. The March of Dimes provided a list of recommended practices, including a form for doctors to fill out noting a valid medical reason for an early delivery, such as a mother who has developed out-of-control hypertension.

Special cases required approval by a lead physician — who is actually the other doctors' peer. At St. Joseph's, most obstetricians are in private practice, not hospital employees.

During the year studied, St. Joseph's rate of elective early term deliveries dropped from 39 percent to just 3 percent. Many doctors involved in those births received quality reviews, resulting in letters informing them not to schedule such deliveries again.

St. Joseph's elective early delivery rate has since declined to less than one percent.

"We sustained and even got better," Howell said.

Overall, hospitals in the study collectively started with an elective early term delivery rate of 28 percent. The six hospitals in Florida were even higher — beginning at 38 percent, said Sappenfield, a co-chair of the March of Dimes prematurity initiative.

By the end of 2011, the hospitals studied — both nationally and within Florida — had declined to 5 percent overall.

Even more dramatic was the drop in the number of elective early term deliveries involving caesarean sections, from 53 percent to 8 percent in Florida, Sappenfield said. That decline was particularly gratifying, he said, since overall, high c-section rates in the U.S. are worrisome to experts.

The issue is considered critical even though just a small percentage of babies born involve elective early term deliveries. In Florida, 4,300 of the 213,000 babies born in 2011 may have been delivered too early unnecessarily, Sappenfield noted.

"This is a regular, everyday occurrence," he said. "When you talk about health care, small things like this can stack up to big costs and big morbidity."

Letitia Stein can be reached at lstein@tampabay.com or (727) 893-8330.

March of Dimes project curbs early delivery of babies at St. Joseph's Hospital 04/08/13 [Last modified: Monday, April 8, 2013 11:15pm]
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