More babies born full-term at Sutter hospitals under new safeguards

04/23/2013 12:00 AM

04/23/2013 12:17 PM

Babies are arriving on their own schedules these days at Sutter hospitals, and that's good for their health, officials say.

Concerned about a nearly two- decade escalation in the rate of elective, early births, Sutter Memorial Hospital in Sacramento and Sutter Roseville Medical Center participated in a national study aimed at making sure more babies spend at least 39 weeks in the womb.

As part of the study, whose results will be published in the May issue of the Journal of Obstetrics and Gynecology, Sutter and other participating hospitals around the country designated a "gatekeeper" whom doctors must go through before scheduling elective deliveries. They also adopted detailed protocols.

The result: a dramatic drop in such so-called "convenience births."

Sutter has since adopted the changes in all of its 24 hospitals with maternity services.

Its efforts coincide with a leveling off of Caesarean section rates in the four-county Sacramento region following an 80 percent jump from 1995 through 2009, according to the U.S. Centers for Disease Control and Prevention.

The study was partly funded by the March of Dimes, which works to improve infant health. The organization was galvanized by concern over a dramatic increase in early deliveries in which doctors performed elective Caesarean sections or induced labor.

In California and in the country as a whole, C-section rate increases became particularly alarming. Not only are early elective C-sections unnecessary; they can be dangerously invasive for the mother and harmful to babies that need to develop in the womb at least 39 weeks, said Dr. William Gilbert, medical director of Sutter Women's Services for the health system's Sacramento Sierra Region.

The final weeks of pregnancy are crucial to an infant's health because many vital organs, including their lungs and brains, are still forming.

A March of Dimes survey, however, found that women were largely unaware that having their babies a few weeks early could harm them. More than half of those surveyed said they believed babies as young as 34 to 36 weeks had developed enough to be delivered safely.

But a baby's brain at 35 weeks weighs only two-thirds of what it will weigh full-term at 39 to 40 weeks, the March of Dimes said.

The risk of death also increases significantly if a baby is born before 39 weeks and nearly doubles for each gestational week earlier than 39 weeks, the March of Dimes study said.

"Women get big toward the end of pregnancy. They are ready for their babies and tired of their pregnancies, so they ask their doctors to deliver early," said Sue Chambers, director of Women's and Children's Services at Sutter Roseville. "What we just didn't realize was we could be putting our babies at risk."

Since joining the study in 2011, Sutter Roseville has achieved a dramatic reduction in early elective deliveries, with zero in the first three months of 2013. In 2010, such deliveries constituted 29 percent of all births at the hospital.

Sutter Memorial Hospital in Sacramento went from having 15 percent of its babies delivered early by choice in 2010 to 2.3 percent in 2012, officials said.

The study examined whether making changes in the protocol for scheduling early births would ensure that more babies made it to term.

The new protocols used by Sutter hospitals were developed in collaboration with the March of Dimes, the California Department of Public Health and the California Maternal Quality Care Collaborative.

Overall, 25 hospitals in five states with the most babies born took part in the program, showing an 83 percent decrease in early elective deliveries – from 27.8 percent to 4.8 percent – within one year.

Gilbert played a key role in the study as Sutter's gatekeeper for early elective deliveries. Each hospital participating had a designated gatekeeper, or final decision-maker.

"If doctors wanted to schedule an early birth, they had to go talk to me personally before they could," Gilbert said.

Saying "no" wasn't always easy, Gilbert added.

"You have physicians who are fairly in-depth in their thinking and they think they know what's best," he said.

Study author Leslie Kowalewski, of the California chapter of the March of Dimes, attributed the success of the program to the meticulousness of its details.

Hospitals were given regular updates showing their progress case-by-case, allowing administrators to closely chart their outcomes.

The program's leaders traveled from hospital to hospital to build face time and strong relationships. Accountability measures were established.

The main ingredient, however, was a downloadable detailed set of instructions, templates and step-by-step forms developed by the three collaborators in California.

"The state of California believed that this would become a go-to document – and it has," said Kowalewski. "In only one year, people all over the country are talking about this program."

For more than 30 years, the American College of Obstetricians and Gynecologists has published guidelines telling doctors to wait until at least 39 weeks of gestation to perform elective early procedures such as C-sections.

The message seems to finally be registering with health care professionals, gathering steam on its own, apparently aided by growing concerns over the costs of unnecessary surgery.

In 2011, about 24.3 percent of hospital deliveries in the four-county Sacramento region resulted in C-sections. That was down slightly from 2010, which, in turn, was down slightly from 2009.

The number of C-sections performed on women who have never had one before also fell slightly last year, according to data compiled by the Office of Statewide Health Planning and Development.

These first-time C-sections are the procedures most likely to be elective. The number of first-time C-sections dropped from about 3,200 to 3,000 in the Sacramento region between 2009 and 2011, a 6 percent drop.

Call The Bee's Cynthia H. Craft, (916) 321-1270. Follow her on Twitter @cynthiahcraft.

Editor's note: This story was changed on April 23, 2013 to reflect babies are born at Sutter Memorial Hospital in Sacramento, not Sutter General Hospital.

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