How Hospital Policies can Help to Prevent Premature Births
Every year in the United States, 1 in 8 babies is born prematurely.
There are many things that women can do (often in conjunction with their care providers) to help prevent preterm birth.
Among other prevention measures, they can quit smoking; they can get screened for infections thought to contribute to preterm labor, including but not limited to bacterial vaginosis, chlamydia, and gonorrhea; they can seek regular prenatal care; and they can even ask their care providers about increasing their intake of Vitamin D, a practice that one recent study has shown to lower the rate of preterm birth.
There are also many things that a society can do to prevent preterm birth.
Universal health care coverage–and, at the very least, universal maternity care coverage–would ensure that every woman has access to regular prenatal care. Working to understand the effects that racism has on premature birth and infant morality also seems to be enormously important. Prematurity awareness campaigns certainly help too.
But there might even be a way for hospitals–not just hospital staff themselves, but hospital policies–to work to prevent premature births.
Simply by placing limits on the number of elective inductions and cesarean sections before 39 weeks gestation, a hospital and its affiliated care providers can decrease the incidence of “late-preterm births.”
According to the March of Dimes:
More than 70 percent of premature babies are born between 34 and 36 weeks gestation. These are called late-preterm births. Late-preterm babies account for most of the increase in the premature birth rate in this country. A 2008 study found that cesarean sections (c-sections) account for nearly all of the increase in U.S. singleton premature births, and this group had the largest increase in c-section deliveries.
What’s more, although late-preterm infants typically have lower morbidity and mortality rates than infants born at earlier gestational ages, this does not mean that they aren’t at a higher health risk than full term infants. As the March of Dimes site also explains, a 2007 study found that late-preterm infants are:
- 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
- 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)
When compared with full-term infants, they are also at a heightened risk for health problems such as breathing difficulty, jaundice, and perhaps even future behavioral and learning disabilities.
So what does limiting early elective inductions and cesarean sections have to do with decreasing incidence of late prematurity?
First, due dates are not always perfectly accurate. In fact, they can be off by as many as two or three weeks, especially if they were calculated using an ultrasound measurement after the first trimester. Thus, if a woman and/or her care provider has chosen a non-medically necessary induction or cesarean section at 37 or 38 weeks, they might actually be causing the baby to be born at 35 or 36 weeks. (This known as iatrogenic, or “doctor-caused,” prematurity.)
In addition, a study published just this month found that obstetrical interventions (such as induction and cesarean section) are related to a recent increase in preterm birth. According to the authors:
From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI] = 1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor.
Thus, if a hospital were to limit the number of unindicated inductions and cesarean sections before 39 weeks, it seems that it could effectively (and perhaps dramatically) decrease the incidence of late-preterm births and it associated complications.
In fact, heeding recommendations from the March of Dimes and the American College of Obstetric and Gynecology, hospitals across the country have already taken steps to limit early elective inductions and cesarean sections.
For the sake of every parent and child who has dealt (and is dealing) with premature birth in the United States, this seems like a huge step in the right direction.
Resources on Infant Prematurity:
Dr. Jen Gunter’s The Preemie Primer