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Robert Imhoff, President and CEO of The Md. Patient Safety Center (The Daily Record / Maximilian Franz)

Md. hospitals lead nation in reducing early births

For several years, doctors and hospitals in Maryland have been trying to make sure expectant mothers stay pregnant for at least 39 weeks, rather than electing to have a cesarean or induced delivery before that point.

As of this week, all birthing hospitals in the state have reduced the rate of these elective, early term deliveries to 5 percent or lower – making Maryland the first state in the country to reach that goal, officials said.

“Many women see 37 weeks as full-term, but 39 weeks is considered full-term,” said Dr. Sam Smith, chair of the Department of Obstetrics and Gynecology at MedStar Franklin Square Medical Center and MedStar Harbor Hospital.

A baby’s brain still has a lot of developing in those two weeks, and babies born at 37 or 38 weeks are more likely to have respiratory and feeding problems, jaundice and even neurological complications, Smith said.

The concern is only for elective procedures; it’s normal for women to go into labor naturally before hitting 39 weeks, and there can be medical reasons for inducing labor early, doctors say.

The statewide initiative against elective deliveries was launched by the nonprofit Maryland Patient Safety Center in 2009. The center worked with several other organizations, including the Maryland Hospital Association, the state Department of Health and Mental Hygiene and the March of Dimes, to spread the word, said President and CEO Robert Imhoff.

“It reduces the risk of harm to both mother and baby, which is what the Patient Safety Center is all about,” Imhoff said.

All 32 Maryland hospitals with birthing units brought their rates of early elective deliveries to under 5 percent and have been recognized by the March of Dimes, said Bonnie DiPietro, the center’s director of operations.

“Our goal is to have as many healthy babies born as possible,” Tina Cavucci, Chapter Director of the March of Dimes Maryland-National Capital Area, said in a statement. “We applaud the Maryland Patient Safety Center and its partners for making Maryland one of the safest states for babies in the country.”

Elective deliveries might be scheduled to better accommodate a doctor’s schedule, or at the request of the patient, DiPietro said.

For years, both women and doctors considered it safe to deliver at 37 or 38 weeks, said Smith.  But in recent years, medical industry standards have changed, he said.

MedStar’s hospitals had been working to reduce early elective deliveries since 2000 but didn’t put a “hard stop” to the practice until 2010, Smith said.  Now, doctors simply aren’t allowed to schedule inductions or C-sections without a medical reason, he said.

Sinai Hospital, which hasn’t allowed early elective deliveries for several years, developed an approved list of medical reasons for such deliveries before 39 weeks, said Dr. Karen Engstrom, the hospital’s chief of obstetrics and gynecology.

If a practitioner wants to schedule an induction for a reason not on the list, the case is referred to a doctor specializing in high-risk pregnancies for approval, Engstrom said.

“It’s the culture [at Sinai],” she said. “Everyone complies with that.”

The Maryland Patient Safety Center launched its latest birth-related initiative in July, this one focused on decreasing the rate of first-time C-sections — even at full term — in situations where the procedure is not medically required, Imhoff said.

Mothers may opt for C-sections for convenience or to avoid pain but don’t think of the procedure as the major surgery that it is, Imhoff said.

Cesarean birth comes with the same risks of infection and complications from anesthesia as any other surgery, DiPietro said.

While safety is the primary concern, cost is another, Imhoff said. “It’s less expensive to deliver as nature intended.”