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.

12 comments:

DBenzil said...

Thanks for bringing this to light. There seems to be so much about US obstetrics-well meaning and "comfortable" (ie all the scheduled births and "necessary" c-sections) but I still am not convinced that quality and health are always the top priority.

pilgrim said...

as a labor and delivery nurse for decades, this post brings tears to my eyes and a lump in my throat, thinking about how many times i have seen this kind of outcome. one is too many. thank you for knowing this and being in a position to possibly do something about it. hug, toni my dear.

Knitted_in_the_Womb said...

I'm a childbirth educator and doula, and I'm glad to see some attention paid to this.

I had a client whose water broke at 32 weeks--gushing fluid. Her Dr. kept her in the hospital for one week. He gave her steriods to mature her baby's lungs. He gave her meds to stop contractions she wasn't even feeling. He tried to give her meds that she wouldn't consent to--trying to scare her with the possibility of a preterm baby. After that week, with her still pregnant, he sent her home. She ended up going into labor at 35 weeks--still preterm--but her baby was born perfectly healthy, never needed any special care, and went home after a normal 2 day vaginal birth stay.

It is worth noting that the OB handling this case had one of his own babies spend time in NICU, which I think affects his decision making with preterm cases--he wants to avoid prematurity in his clients as much as possible.

On the flip side, I know a woman whose Dr. *suspected* that her water broke at 28 weeks. This suspicion was based on ultrasound showing progressively lower fluid levels over a period of a few days. The baby was not in distress. The maternal fetal medicine Dr. made the decision that the baby needed to be born immediately, and a cesarean was performed. The baby spent 3 months in NICU, and now, at age 2, still needs extensive therapy. I wish I knew if that baby really needed to be born so early. I've just always had the nagging suspicion that he would have been much better off if he'd stayed in his mother's womb longer.

Mike said...

I'm grateful that you were able to raise this issue on child birth. There are many cases of premature births that should be taken into consideration as to why pre-term birth has been chosen in the first place. My friend told me situations wherein newly-born (premature) babies died because of wrong decisions. It also happens in Ottawa. Personal injury lawyers are keen about these cases since physicians are involved in some birthing processes. Also, it is expected that prudence and concern must go hand in hand when it comes to delivery of a baby since it involves the life of the mother and the baby, right? Thanks for the informative post.

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Anonymous said...

My ob wanted to deliver my baby early in December because my due date was the 26th and she didn't want to be called out of her Christmas celebration. I nixed that Idea pretty fast and my baby was born 2 weeks late in January and weighed just 6 pounds. I can't imagine how tiny he would have been had I let her induce my labor so early. Scary!