This past Wednesday, in Washington, D.C., HCA was recognized at a press conference called by the Secretary of the US Department of Health and Human Services for our work in reducing elective, early-term deliveries and achieving better outcomes for mothers and newborns. While announcing a new Federal initiative to reduce elective preterm births nationwide, Dr. Richard Gilfillan, Director of the Center for Medicare and Medicaid Innovation at HHS, cited HCA’s hospital-based research and published studies on early elective deliveries. Last month, Leapfrog, a consumer advocacy group, also referenced HCA’s work during their annual review of US hospital rates of early elective deliveries.
This is welcome recognition for “My 39 Weeks™,” an initiative that can be traced back to 2007. Many organizations have raised concerns about early term delivery; HCA was approached five years ago to determine if there is scientific basis for the traditional definition of term at 37 to 39 weeks gestation. In other words, are babies born prior to 39 weeks as healthy and robust as those born at 39 weeks and beyond? Traditionally, term had been defined as 37 to 42 weeks, and deliveries at less than 39 weeks were not considered a risk for mothers or newborns.
Since HCA delivers about 225,000 babies annually (6% of all US babies!), we were presented with a unique opportunity to answer these questions. We rallied about 27 hospitals and looked at nearly 18,000 deliveries over three months. We found that there is an increased risk of illness, such as lung immaturity leading to respiratory distress, for infants delivered electively at 37 and 38 weeks, as compared to those delivered at 39 weeks or later. We also found four times fewer complications requiring admission to neonatal intensive care units (NICU) at 39 weeks, as compared to 37 weeks, and there were two times fewer complications at 39 weeks than at 38 weeks. (Please note that this refers only to admissions associated with elective, scheduled deliveries, either induced or by C-section, and does not refer to admissions made necessary by maternal or fetal distress or early labor.) Outside of medical indications, it became absolutely clear that the best thing for the health of the baby is not to do early elective deliveries.
In a follow-up study, HCA-affiliated hospitals where measures to reduce early elective deliveries were adopted showed a 16% reduction in NICU admissions over a two-year period. Hospitals where medical staff adopted a “hard stop” policy reported twice the rate of decline in elective early deliveries as those with less restrictive measures. That has since led medical staff at the majority of HCA’s 111 hospitals offering perinatal services to implement similar “hard stop” policies, resulting in approximately 96% of deliveries at all HCA-affiliate hospitals occurring at 39 weeks gestation or beyond. That compares favorably with the current national rate of about 85%.
Clearly, a major benefit of this new science is avoidance of the incalculable harm and grief that results from adverse outcomes. There are other benefits, including an increase in efficiency and a reduction in cost. It has even been calculated that if all babies in the U.S. were delivered without early elective deliveries, that would equate to approximately $1B in overall cost savings.
“My 39 Weeks™” began in response to long-standing questions about the health risks associated with early term delivery. With those questions answered, there’s clearly a new focus on this vitally important issue, and I’m proud of this national recognition of HCA’s commitment to the health of mothers and babies. After all, I’m a father, too.