Ky. health officials seek to stop trend of elective deliveries

mmeehan1@herald-leader.comMarch 1, 2013 

FRANKFORT — Because babies fare better when they are carried to term, Kentucky health officials are attacking the trend of elective deliveries and pushing for "hard stop" policies allowing early induction or C-section only when medically necessary.

About 18 percent of Kentucky babies are born via elective early deliveries such as induction or C-sections. That practice doubled between 1990 and 2006, matched by an increase of pre-term babies born before 39 weeks, said Donna Meador, project director of the Kentucky Hospital Association engagement network.

Stemming the practice, she said, could prevent millions of dollars being spent in health cost and significantly improve the health of newborns who are at risk for a host of medical problems when born too soon. Early delivery is a problem across the country, she said.

Meador spoke Friday at the Governor's Summit on Infant Mortality in Frankfort sponsored by the Kentucky Department for Public Health.

Gov. Steve Beshear told the conference that nearly every day a baby dies in Kentucky before age 1 and Kentucky babies have consistently died at higher rates than those born in other states.

"I don't have to tell you how fragile the first months of life are or how important it is for health care providers and public officials to do everything we can to help parents protect their children," Beshear said.

Helping change mortality statistics and overall health statistics for newborns by making sure babies are carried to term is a rare health goal that is obtainable and affordable, Meador added.

"It's free," she said. "All it takes is hospitals adopting a policy."

A group of public and private agencies, including the March of Dimes, have been working for about a year to push for change, she said. Under a "hard stop" policy, doctors would have to provide a medical reason for an early delivery. Currently, doctors can simply schedule a patient without citing a medical need, she explained.

The "hard stop" policy has already been adopted by some of the state's 47 birthing hospitals, but it needs to be standard practice to be truly effective. In part, so doctors hoping to get around the policy don't simply switch to a hospital with less stringent rules, she said.

Doctors, families and hospitals contribute to the problem, she said. Doctors may push back against someone telling them how to do their job. Families pressure doctors for a particular birthday, hope for a birth to coincide with the availability of childcare or plead for early delivery to end a grueling pregnancy. Hospitals may schedule a single doctor's operation the same day each week and not be flexible.

Once the public is educated about the long-term health benefits of full-term pregnancy it will respond, Meador said, adding that hospitals now have an added incentive, money. Medicaid is already limiting payments for pre-term, elective deliveries, she said.

Mary Meehan: (859) 231-3261. Twitter: @bgmoms. Blog: BluegrassMoms.com.

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