Going the distance: Hospital honored for ending early elective induction

By BRYN STOLE; Staff Writer

When it comes to delivering a baby, the growing consensus in health care seems to be that waiting longer is nearly always better.

Some big changes rolling out statewide this year will push more parents to delay delivery until after a pregnancy hits full term, but Greenwood Leflore Hospital has been well ahead of the curve in Mississippi.

The hospital was recently recognized by the March of Dimes, a national nonprofit that works to improve the health of mothers and babies, for ending elective early induction of labor, in which doctors begin the birth process  for non-medical reasons before a pregnancy hits 40 weeks.

Amy Brower, director of maternal child health at GLH, said the hospital — which delivers about 600 babies each year — hasn’t had an elective early delivery since April 2013.

The hospital’s decision to stop performing elective early induction is now being copied by some of the state’s insurers, including Blue Cross & Blue Shield of Mississippi, which stopped paying for the procedure at the start of this year.

Greenwood Leflore Hospital moved to cut back on the practice after medical studies showed lengthier pregnancies are strongly correlated with healthier children and lower instances of ailments such as autism, asthma and attention deficit disorder — even for babies born at 36 or 37 weeks and not considered premature.

Only babies born before 36 weeks are formally considered premature, Brower said, but other babies born between 36 and 40 weeks — which she called “pre-term” — have still shown a higher rate of health issues.

The final weeks of pregnancy are also strongly associated with the development of a baby’s brain, meaning delaying a birth can give children more time in a crucial phase of development, Brower said.

“Statistics show that babies do better when they stay in longer,” Brower said. “Period.”

Shortened pregnancies are also linked to higher rates of health issues requiring babies to be treated in neo-natal intensive care. That’s worse for a baby’s health but can also drive up health care costs exponentially, Brower said.

Several weeks in intensive care for a newborn baby can cost millions of dollars.

Cutting back on elective early delivery required a changing approach to pre-natal care for the hospital, including more conversations and discussions with expectant mothers early in a pregnancy, said Rebecca Edwards, GLH’s chief nursing officer.

“It takes some education on the part of the staff working with the parents,” Edwards said. “Delivery has been something that mothers thought they could schedule.”

Working more closely with expectant mothers is also part of a larger shift in the way hospitals provide support and treatment for pregnant women.

Brower said the hospital is also working to increase the percentage of mothers who breast feed and is looking to revamp its care for mothers and babies following birth toward “couplet care,” where infants are kept together with their mothers instead of being placed in a nursery.

Although the hospital is no longer inducing pregnancies early by choice, other babies are still born there prematurely for medical reasons, often because of complications during pregnancy.

Brower said the population in the Delta — with high rates of hypertension, obesity, diabetes and other chronic disorders — tends to be at higher risk for pregnancy complications including preeclampsia. When those sorts of medical issues surface, early induction can be the best option for protecting the health of both the baby and the mother, Brower said.

“If (the mother) needs to be induced … then you need to evaluate the risks of delivering the baby early with the risks of her staying pregnant,” Brower said.

There, too, attention early in a pregnancy is key to preventing serious health issues and keeping babies inside their mothers for as long as possible, Brower said.

Early screenings can help identify those at risk. Brower said that health care providers and insurers — including Medicaid — have moved toward providing increased levels of preventative care during pregnancy in an effort to cut down on post-birth health issues among babies.

Even after the birth, keeping mothers and babies close together seems to lead to healthier, happier and calmer children, Brower said.

“The old-timey way of papoosing the baby to a mother’s back really is the way to go,” Brower said.