Minn. tells the stork: Take your time

  • Article by: JEREMY OLSON , Star Tribune
  • Updated: November 15, 2010 - 11:50 PM

Minnesota hopes to discourage the practice of inducing labor before 39 weeks by adding extensive paperwork for every state-funded delivery.

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Dr. Michael Spence spoke with Gina Jacobsen of West St. Paul, 38 weeks pregnant, at the Eagan Allina Medical Parkview OB/GYN office.

Photo: Bruce Bisping, Star Tribune

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Minnesota might become the first state in the nation to create a policy against a common practice in obstetrics: inducing childbirth early just for the convenience of doctors or mothers.

Mindful of research showing health problems with babies delivered early, the state Department of Human Services has proposed that hospitals create plans by 2012 for reducing elective inductions prior to 39 weeks gestation. The penalty for those without plans? Fill out onerous paperwork for every state-funded delivery.

The policy would sync with a campaign by the March of Dimes to encourage women to carry their pregnancies the full 40 weeks whenever possible.

"Just because we have the tools [to induce labor] doesn't mean we should be using them," said Marianne Keuhn of the Minnesota chapter of March of Dimes, an advocacy group that promotes healthy babies and pregnancies.

While 37 weeks gestation is considered full term, research has shown higher rates of respiratory problems, longer hospital stays and intensive care for babies born before 39 weeks. Induced labor before 39 weeks also increases the rate of emergency C-section deliveries.

The rate of induced labor has tripled in the United States since 1990. Roughly one in five deliveries in Minnesota are now medically induced, often with the intravenous drug Pitocin. The state does not know how many are elective and how many are necessary, but the proposed policy would require hospitals to report induced deliveries and the reasons.

Some women seek inductions to end what seem like interminable third trimesters. A few want to avoid deliveries on Halloween -- or certain Zodiac signs for their children, said Dr. Stan Davis, medical director of simulation and teamwork for Fairview Health Services.

"I'm all for consumerism," Davis said. "But when it creates a problem like this, it's not good."

The policy would not limit inductions for medical reasons or conditions that make continuing a pregnancy risky. Its target is deliveries that are scheduled early to suit doctors' vacation schedules, or when expecting mothers know relatives will be in town to help with their newborns.

The specter of more paperwork should suffice to motivate doctors and hospital administrators, said Dr. Jeff Schiff, medical director of the Human Services Department. Officials opted against a more heavy-handed idea: denying state payment for elective inductions prior to 39 weeks. Medicaid, known in Minnesota as Medical Assistance, pays for 38 percent of births in the state.

"No one is losing money. That's not the goal here," Schiff said. "The goal is to use our policies to ... encourage what everybody knows to be good medical practice."

Schiff will discuss the policy Nov. 17 with doctors, hospital leaders and insurers as a first step toward making it official. Keuhn said Minnesota could be the first state with a policy solution, though Hawaii, New Jersey, Oklahoma and other states are confronting elective inductions, as well.

Changes at Fairview

Fairview was an early leader on the issue in 2008, when it formally discouraged early elective inductions at its metro-area hospitals.

Since then, Fairview's rate of elective inductions has dropped below 1 percent. Birth complications have dipped, as well. The average APGAR score -- a 10-point rating of newborn health -- increased from 4.8 to 5.5 for babies born in Fairview hospitals.

Davis said there is growing momentum against early elective inductions. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the national body that accredits hospitals, just added induction rates as one option for hospitals to track to gain accreditation. "This has been a growing practice," said Ann Watt, an associate director of quality measurement for JCAHO. "I think, because of its growing prevalence, people were able to see the negative effects."

At week 38 of her pregnancy, Gina Jacobsen is anxious to give birth to her second daughter. Inducing labor, though, wasn't a thought for the West St. Paul woman.

"She can come whenever she wants," Jacobsen said, "as long as she comes soon!"

Stephanie Dickinson is only at week 28 of her pregnancy, but the sonographer at Allina's obstetrics clinic in Eagan is thinking about scheduling her delivery. Then she could arrange child care for her kids at home while she recovers.

Of course, the deliveries of her other children were both early, she said. "If I make it to 38, I will ask."

Hospitals vary

Minnesota hospitals vary widely in their induction rates, according to data from the Department of Health. Eight percent of the 4,138 babies born at Abbott Northwestern Hospital in Minneapolis were induced in 2009, and only 2 percent were induced prior to 39 weeks gestation. By comparison, 38 percent of the 590 births at New River Medical Center in Monticello, Minn., were induced, and 10 percent were induced before 39 weeks.

But scheduling a delivery isn't always about convenience, especially at smaller, rural hospitals. Some schedule deliveries during the day, when they have anesthesiologists and other specialists on hand to handle complications. Inducing labor might also be preferable for mothers who live miles away.

The highest reported rate was at First Care Medical Services in Fosston, Minn., where 64 of 78 deliveries were induced, and 29 inductions took place prior to 39 weeks. Chief executive Patricia Wangler said the data is incorrect, probably because of a new records system. While the hospital serves a remote region of northwest Minnesota, Wangler said it is "rare" for her doctors to schedule deliveries just because patients live far away.

Schiff said the key to progress will be broad participation by hospitals and consistent information for mothers.

"Then everyone will get the same message," he said, "that convenience is less important than the health of the babies."

Jeremy Olson • 612-673-7744

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