Friday, January 22, 2010

Most women incorrectly think it’s safe to deliver a baby before 39 weeks.

A couple of times I’ve blogged about the need to cut down on elective C-sections performed before women reach the full term of 39 weeks. It’s a risky procedure that ends up putting far too many newborns in neonatal intensive care units (NICU).

I have always wondered why women allow themselves to undergo a procedure that’s so risky for their newborn instead of waiting until full term.

A new survey answers the question. The survey reveals that most women don’t know delivering a baby before the full term of 39 weeks puts the newborn at greater risk than waiting until full term.

The study, by UnitedHealthcare and the Department of Obstetrics and Gynecology at Drexel University College of Medicine, found that 92.4 percent of the women surveyed believe that it is safe to deliver before 39 weeks despite the American College of Obstetricians and Gynecologists (ACOG) recommendation that scheduled deliveries should occur only after 39 weeks of gestation.

The study of 650 insured first-time mothers also found that 51.7 percent of respondents believe it is safe to deliver before 37 weeks of gestation, while73 percent believe that it is safe to deliver before 38 weeks. Shockingly, 24 percent believe full term is reached before 37 weeks of gestation.

Tina Groat, a physician who is the national medical director of Women’s Health for UnitedHealthcare, said it best: “The results of this study are quite compelling and underscores the importance of proactively educating female patients on the dangers associated with elective deliveries prior to 39 weeks.”

Research shows that babies born between 34-36 weeks are not only more likely to die than full term infants; if they survive they are more likely to develop cerebral palsy and have developmental delays than babies born full term. Also, a growing body of recent research reveals that newborns delivered prior to 39 weeks are up to two-times more likely to end up in NICU than babies born at 39 weeks, and are at increased risk for complications including respiratory problems, feeding difficulties, delayed brain development, and death.

Even though ACOG cautions against elective delivery by induction or C-section before 39 weeks of gestation, the rates of early births (between 34-36 weeks of gestation) are on the rise. Currently, more than 1.3 million C-sections are performed annually in the United States, often at an increased risk to newborns, according to the federal Agency for Healthcare Research and Quality (AHRQ).

A nationwide study published in the January 2009 edition of the New England Journal of Medicine found that 35.8 percent of elective C-section deliveries were performed before 39 weeks of gestation, while a recent review of UnitedHealthcare data for mothers and their newborns showed that 48 percent of newborns admitted to the neonatal intensive care unit were from scheduled admissions for delivery – many before 39 weeks gestation.

The objective of the new UnitedHealthcare attitudinal study was to determine women’s understanding of the definition of full term pregnancy, the gestational age at which it is safe to deliver an otherwise healthy pregnancy, and in turn, investigate consumer knowledge and attitudes related to C-sections and induced deliveries. The study, which used data from a survey commissioned by UnitedHealthcare, is part of an 18-month analysis by UnitedHealthcare of elective deliveries and the associated neonatal complications for babies delivered by early scheduled C-sections.

Based on the data of this study, UnitedHealthcare will begin to focus on engaging and empowering women through education and other resources to ensure that women understand the implications of the timing of delivery. Patient-focused initiatives will round out our effort to implement a holistic approach, both provider- and consumer-driven, to reduce neonatal risk. Over the past year or so, we have focused efforts on educating providers, including physicians and hospitals regarding the risks associated with these scheduled procedures.

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