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Hospitals Take 'Hard Stop' On Early Elective C-Sections, Inductions

Beginning next month, many pregnant women in Oregon will no longer be able to have the early delivery they've been dreaming of.

On Sept. 1, Oregon will become the latest state where some hospitals are refusing to do elective, non-medically necessary inductions and cesarean sections before 39 weeks of pregnancy. The goal is to give babies more time for important development and to reduce costly complications after birth.

Seventeen Oregon hospitals — including all nine birthing hospitals in the Portland area — have agreed to a “hard stop” on the elective procedures, according to the March of Dimes’ Oregon chapter, which announced the agreement earlier this month. The agreement covers about half of the deliveries in the state.

The number of cesareans and inductions at 37 and 38 weeks has been growing as women schedule their deliveries for their convenience or to be delivered by their own doctor, says Michele Larsen, the Oregon chapter’s communications director. Deliveries at those weeks have risen in the U.S. in the last decade and now account for 17.5 percent of live births, she said. About one in three C-sections are done before 39 weeks, according to a 2009 study published in the New England Journal of Medicine.

Technically, full term is 37 to 41 weeks, Larsen said, but the group believes the longer the term the better for babies.

“Thirty-nine to 40 weeks is the gold standard,” Larsen said. “So much more research is coming out showing how vital those last weeks are to the development to the children’s brain, liver and lungs. It makes a huge difference.”

Dr. Carey Winkler, a maternal and fetal medicine doctor with one of the 17 hospitals, Legacy Health system, agrees.

“Babies born in the early-term time frame are at increased risk of complications, which increases the costs to the health care system,” Winkler said of those born from 37 to 39 weeks. “In the short run and the long run, these kids have more problems.”

The problems include increased risk for respiratory problems, jaundice, feeding problems, temperature instability and greater risk of being re-admitted to the hospital for poor weight gain or failure to thrive, he said.

“The closer you are to 39 weeks, the risks decrease, so it’s just better to wait,” he said.

Nationwide, the C-section rate reached a high of 34 percent in 2009, according to a study by HealthGrades. While a cesarean is generally considered safe, it’s still a major procedure that carries risks like bleeding and infection for the mother.

The new policy may lower that rate in Oregon once women have more time to go into labor on their own before an elective induction, which carries a risk of needing a C-section if the induction fails, experts say.

Dr. Stella Dantas, a Portland obstetrician and spokeswoman for the American College of Obstetricians and Gynecologists, is hopeful that the Oregon policy will lead to fewer cesareans in her state.

“We’re hoping that this will decrease the cesarean rate,” she said. “The C-section rate nationally is concerning for all ob/gyns.”

The Oregon agreement comes as the March of Dimes has been working on the issue across the country. About six or seven other hospitals — in California, Texas, New York and Illinois — have adopted the ban on early elective deliveries, said Leslie Kowalewski, assistant state director of the March of Dimes’ California chapter. Intermountain Healthcare, which has 23 hospitals in Utah and Idaho, has had the policy for the last decade.

“There’s multiple hospitals that have this hard-stop in place,” Kowalewski said.

But they are in the minority, she said. “The flywheel is starting to turn,” Kowalewski said. “We’ve got a good start but we’ve all got to keep on pushing.”


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