Albany area hospitals help reduce preterm deliveries

Region’s hospitals reduce scheduled preterm deliveries

By Claire Hughes

Published 8:54 pm, Tuesday, January 13, 2015

Sixty-three maternity centers, including six in the Capital Region, were recognized by the state Health Department Tuesday for their low number of early deliveries scheduled without medical reason.

The statewide goal is to bring down the number of preterm births, before 39 weeks gestation, which can lead to serious medical problems for babies, including inadequate brain development.

In the Capital Region, facilities receiving quality awards include Albany Medical Center, Bellevue Woman’s Center, Saratoga Hospital, Glens Falls Hospital, Nathan Littauer Hospital and Columbia Memorial Hospital.

“Preterm birth can lead to severe health problems, including difficulty breathing and feeding, vision impairment, and developmental delays,” state Health Commissioner Howard Zucker said in a statement. “The brain is the last major organ to mature in babies; the more prematurely a baby is born, the more likely it is that bleeding or other stressors will affect the brain.”

Albany Med, Columbia Memorial and Nathan Littauer reported fewer than three scheduled deliveries without medical need for all of 2013. Bellevue, Saratoga Hospital and Glens Falls Hospital reported fewer than three such deliveries in the six-month period from July to December 2013.

Two Capital Region birthing centers, St. Peter’s Hospital in Albany and Burdett Care Center in Troy, were not on the list of those recognized. A spokesman for St. Peter’s was not able to provide information Tuesday on the number of early scheduled deliveries in 2013 that were not medically necessary. A spokesman said Burdett Care Center had only one early, scheduled, medically unnecessary delivery during 2013, but did not report its data to the state in time to be considered for the Quality Award.

The local maternity centers were among 97 to participate in the New York State Perinatal Quality Collaborative, a Health Department initiative to reduce the number of babies whose births were induced or completed through cesarean section, without a medical need for those procedures. Collectively, these hospitals reported a 92 percent decrease in scheduled deliveries for no medical reason between 36 and 39 weeks gestation, between June 2012 and December 2013.

The figure includes an 86 percent decrease in inductions, when medication is used to start a pregnant woman’s labor, and a 94 percent decrease in cesarean sections, when a baby is surgically removed from the mother’s abdomen.

The effort was targeted only at elective inductions and C-sections, not at those done for the health and safety of either mother or baby. There remain sound medical reasons to induce labor or perform a C-section before 39 weeks, noted Dr. Kevin Kiley, chairman of obstetrics and gynecology at Albany Medical Center. Those include high blood pressure, vaginal bleeding or a serious infectious illness in the mother, or an abnormal heartbeat, irregular growth or other signs of struggle in the baby.

What doctors and health officials are aiming to reduce are scheduled inductions and C-sections done for purely elective reasons, including sheer convenience, Kiley said. He listed a few reasons mothers chose this option: “I’m tired of being pregnant, my feet are swollen, my husband’s going to Afghanistan, I want Dr. Kiley to deliver the baby and he’s going on vacation next week.”

For decades, scheduling such deliveries after 37 weeks was not considered a problem, Kiley said. But a 2007 study by Utah-based Intermountain Healthcare began to change the thinking of the medical community, he said. It showed babies born before 39 weeks gestation were at higher risk for complications, including serious ones that required costly care in the neonatal intensive care unit.

“We were putting babies in the NICU just because mom wanted to have her baby while her mother was in town,” Kiley said.

By 2010, health officials were beginning to urge birthing centers to cut back on the numbers of elective births before 39 weeks.

By that time, Albany Med had begun its own efforts to reduce such births, Kiley said. It instituted strict rules prohibiting the scheduling of inductions or C-sections even as late as the last day of the 38th week.

In 2011, perhaps 18 percent of scheduled C-sections at Albany Med were not medically necessary, Kiley said. In 2013, just one in about 330 scheduled C-sections could be considered elective.

One big challenge in these efforts has been educating pregnant women on the risks associated with early scheduled delivery, local health system representatives said.

“Some of the physicians will tell you that they get a lot of pressure from their patients, and I really think it’s just that they don’t understand the potential risks,” said Karen Lantzy, administrative director of women’s services at Bellevue.

Bellevue will sponsor the showing of a movie, “Go the Full 40,” at Colonie Center on March 31 to help educate area residents on the benefits of carrying a baby through 40 weeks of pregnancy, Lantzy said.

The state Health Department reported Tuesday that birthing centers in the collaborative documented a 41 percent increase in educating pregnant women on the risks and benefits of preterm scheduled delivery.

chughes@timesunion.com • 518-454-5417 • @hughesclaire

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