US hospitals are reducing early elective deliveries

BMJ 2013; 346 doi: (Published 04 March 2013) Cite this as: BMJ 2013;346:f1417
  1. Janice Hopkins Tanne
  1. 1New York

Rates of early elective deliveries by induction and, in some cases, caesarean section are falling in US hospitals, shows a national survey.

The proportion of deliveries before 39 weeks fell from 17% in 2010 to 11.2% in 2012, found the survey, carried out by the Leapfrog Group, a coalition of large corporations that buy healthcare benefits for their workers.1 The report was based on a survey of nearly 800 US hospitals, representing about a third of US hospitals with maternity services.

“Term” is usually considered to be 37-41 weeks of gestation. Babies born before 39 weeks are more likely to have problems with feeding and breathing or infections that land them in the neonatal intensive care unit. Early induction of labor also means that the mothers have a higher risk of needing a caesarean section. These problems lead to higher healthcare costs.

The Leapfrog Group said that it would like to see rates of early delivery no higher than 5%. At present the rate ranges from 26% in Pennsylvania to only 5.9% in Massachusetts and New York City.

For more than 30 years the American College of Obstetricians and Gynecologists has recommended against delivery before 39 weeks unless there is a medical reason. Other organizations also speak against early delivery. Nevertheless, between 10% and 15% of US babies are delivered early without a medical cause, the Department of Health and Human Services said.

A study last year found that babies born “at term,” but early, lagged in school achievement eight years later. That New York study followed more than 128 000 singleton pregnancies and found that babies born at 37 and 38 weeks did less well in school than babies born at 39 to 41 weeks.2

Leapfrog’s chief executive officer, Leah Binder, said that some hospitals may have been reluctant to pressure doctors to change their practices. In rural hospitals doctors may try to schedule deliveries to stagger their workload. Women may also try to schedule an early delivery for convenience.


Cite this as: BMJ 2013;346:f1417