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Decline seen in early scheduled births

Efforts by hospital and government officials to decrease the percentage of babies born before full term appear to be paying off in Massachusetts and nationwide, according to a new report.

Last year, Massachusetts hospitals performed just over 1 percent of their deliveries on average as early elective deliveries—via scheduled induced deliveries or cesarean sections for no medical reason—before 39 weeks, compared to a statewide rate of 15 percent in 2010.

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Nationwide, hospitals saw their rates for such procedures fall to fewer than 5 percent last year, down from 17 percent in 2010.

The figures were released Monday by the Leapfrog Group, a nonprofit hospital quality watchdog organization, and were provided voluntarily by hospitals.

Such improvements could improve bode well for the health of newborns since a growing body of evidence suggests that babies born between 37 and 39 weeks gestation—full term is 40 weeks—have a higher risk of health problems. A greater percentage wind up in the neonatal intensive care unit and have longer hospital stays, often due to breathing or feeding problems.

They may also have a slightly higher increased risk of dying because their brain and lungs have not had the full time to develop in the womb.

Three years after Massachusetts health officials formed a collaborative with hospital leaders, obstetrician-gynecologists, and the March of Dimes to lower early delivery rates, all of the maternity hospitals in the state that provided data to Leapfrog met a recognized goal standard of reducing their rate to below 5 percent of all deliveries. (Nine out of the state’s 50 licensed maternity hospitals did not provide data to the group.)

“It’s a success story,” said Dr. Glenn Markenson, chief of maternal fetal medicine at Baystate Medical Center in Springfield and past chairman of the Massachusetts Perinatal Quality Collaborative. “We had a lot of buy-in from hospitals. Most had no idea their rates were so high until they started keeping records.”

Baystate was among the first to ban early deliveries for no medical reason several years ago, and Markenson said he’s now collecting data to determine whether it has led to a lower rate of health complications in babies born there.

Only 2 percent of births last year at Brigham and Women’s Hospital were performed as early scheduled deliveries, compared to 27 percent in 2010, according to the Leapfrog report. At Heywood Hospital in Gardner, just 1 percent of all births last year were early and scheduled, compared to 53 percent of births three years earlier.

Some of the dramatic drops, Markenson said, may have been due to changes in how hospitals defined these births; many did not keep careful records in 2010 to track when doctors performed early deliveries for possible medical reasons like a sudden rise in the mother’s blood pressure.

While about one-third of the Massachusetts birth hospitals already had instituted rules discouraging early deliveries before 2010, the rest waited until more recently to toughen their stance.

“We were told to put in a hard stop on delivering women before 39 weeks,” said Dr. Allison Bryant Mantha, a high-risk obstetrician at Massachusetts General Hospital. “In order to book an induction of labor, we now need to report the gestational age and the reason for delivery. Doctors know that the hospital is watching.”

MGH’s early delivery rate fell from 8 percent in 2010 to zero.

Women who ask their doctors to induce labor two or three weeks early because they’re feeling uncomfortable or want to make the birth come in time to take the yearly tax deduction will now be told by nearly every birth hospital in the state that they can’t do so under hospital rules.

There are, though, medical reasons that still warrant an early delivery to protect the health of the baby and mother, Mantha emphasized. These include a mother’s development of high blood pressure or pre-eclampsia, a failure of the fetus to grow properly, or abnormalities seen in the placenta.

A handful of hospitals reported a slight rise in their early schedule childbirth rates, but these had already put in place firm rules to change their practices.

Boston Medical Center’s rate, for example, went from 0 percent to 1.3 percent over the three-year period.

“It’s probably natural variation and is very small in terms of actual numbers of births,” Markenson said. “A woman may say that her husband is leaving for Iraq, and she would like to have elective C-section at 38.5 weeks, which the hospital consented to; there will always be a few exceptions.”

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