Sunday, April 25, 2010
Preterm Childbirth Caused by Physicians
Babies born between the 34th and 36th week have more complications and the cost in the U.S. is $26 billion annually. These children have more risk of death, cerebral palsy, cognitive impairment or respiratory problems. In the United States, nearly 13% of infants are born before they reach 37 weeks gestation. According the the Society for Maternal-Fetal Medicine (SMFM), that rate is much higher than other developed nations and physicians may be partially to blame for the early deliveries.
Some of the reasons may be older moms or the increased use of artificial productive technology and multiple births. But they are finding that some physicians are choosing to deliver between 34 and 37 weeks even when there is no clear medical indication. SMFM analyzed data of 250 late preterm births and found that the indication for these early deliveries did not meet accepted medical indication in 20% of the cases. Another study from Columbia University Medical Center showed similar results that deliveries were performed without an indication supported by evidence.
Of all the specialties, Obstetricians have the most at stake in caring for patients. They actually have two patients, the mother and the child. There is nothing more heartbreaking than a "bad baby"...the term we use for a terrible maternal outcome and the Obstetrician is usually blamed if the baby does not come out perfect. It is no wonder that they want to deliver the child at the first signs of problems (hypertension in the mom, anxious parents).
Review of all preterm deliveries should be performed by the quality committee at the hospital. These are usually physicians in that specialty who can understand the thought process that was used by the physician. Education can be instituted if the doctor is delivering outside of guidelines. We need more internal controls and patient safety reviews to understand the role that medical interventions play in preterm deliveries.
Posted by Toni Brayer, MD at 9:25 AM