Article - Hospitals to crack down on induced labors

[Anonymous]

http://www.msnbc.msn.com/id/33483153/ns/health-pregnancy/

A couple of snippets from the article:

Most were being induced in week 37, such a small difference that local obstetricians argued it wasn't a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator.
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New guidelines will require that a mother's cervix be nearly ready for natural labor, and limit the hospital beds available for elective inductions.

More hospitals are expected to start enforcing that criteria this spring, when the Joint Commission that regulates health quality will require hospitals to report all elective deliveries and the gestational age to its public database, providing peer pressure for improvement. Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction.

[Anonymous]

Excellent news!

[Anonymous]

ugh. i'm 39.5 weeks and i wish i could be induced now.

[Anonymous]

Anonymous wrote:ugh. i'm 39.5 weeks and i wish i could be induced now.

I hear you. When I saw the article, I thought this is great. Then I thought, easy for second trimester me to say, there are probably some near-term women out there who will cringe upon reading this. Hope your little one comes soon!

[Anonymous]

Interesting.

I'm surprised women would agree to induction at only 37 weeks. I wouldn't have agreed to do it three weeks early. I had 3 inductions, one baby was born at exactly 40 weeks on her due date, and the other two were 39 weeks 5 days, and I was at least 2cm dilated on my own each time.

[Anonymous]

Anonymous wrote:Interesting. I had 3 inductions, one baby was born at exactly 40 weeks on her due date, and the other two were 39 weeks 5 days, and I was at least 2cm dilated on my own each time.

Just out of curiousity - why were you induced three times?

[Anonymous]

There are many reasons to perform an elective induction, such as if mom lives two hours from a hospital, notes Dr. John Fisch of the University of Pittsburgh Medical Center's Magee-Women's Hospital.

Hmm. This strikes me as a reason to build a new hospital or birth center, not a reason to schedule an induction.

[Anonymous]

I see what you're saying, but... build a new hospital or birth center just so every woman is within an hour or so of a hospital? Have you ever been in a little town or a rural area? That's not a realistic goal.

[Anonymous]

Anonymous wrote:There are many reasons to perform an elective induction, such as if mom lives two hours from a hospital, notes Dr. John Fisch of the University of Pittsburgh Medical Center's Magee-Women's Hospital.

Hmm. This strikes me as a reason to build a new hospital or birth center, not a reason to schedule an induction.

I'm guessing you've never visited North Dakota, Montana, or Wyoming.

Perhaps though they could move the mom into town for the last few weeks of her pregnancy. I agree that I do not understand induction at 37 weeks unless it is medically necessary.

[Anonymous]

Anonymous wrote:

Anonymous wrote:There are many reasons to perform an elective induction, such as if mom lives two hours from a hospital, notes Dr. John Fisch of the University of Pittsburgh Medical Center's Magee-Women's Hospital.

Hmm. This strikes me as a reason to build a new hospital or birth center, not a reason to schedule an induction.

I'm guessing you've never visited North Dakota, Montana, or Wyoming.

Perhaps though they could move the mom into town for the last few weeks of her pregnancy. I agree that I do not understand induction at 37 weeks unless it is medically necessary.

There was a health plan that paid for this recently - the mom was having complications during pregnancy and had to stay in the hospital. When she was ready to be released to spend the remainder of the pregnancy at home, the hospital was concerned because she was 2 hours from the hospital. So the health plan paid for her and her husband to stay at a nearby hotel, saving something like several thousand a week. Good for mom (since no one should be at a hospital if they don't want to be) and good for health care costs, since hospital stays are so expensive.

Personally I think it makes sense - even if you are not high risk, to avoid an induction it would be worth it to me.

[Anonymous]

There are still TONS of elective inductions in urban areas, like D.C. so that excuse only covers so many situations.

[Anonymous]

I was induced when my water broke and I didn't go into labor for 48 hours (patient midwives). I was overdue. I can't imagine an elective induction that early, what if you are off on the dates? I've know people to do it so that they had covereage fofr care for older DC although most went with an elective c instead.

[Anonymous]

I went to the doc at 39 weeks and 4 days and they siad they won't even schedule an induction until 40 weeks. They won't let me go any longer than a week over which is nice but I went to 41 weeks with my first and was really hoping to NOT have to do that again with this one. I will be 40 weeks Friday and have just chalked it up to "I guess they have their resasons". Yea, I am tired and achy and want to meet my new little one but medically they know better than me!

[Anonymous]

Interesting. The studies showing the adverse affects of inductions and c-sections at 37 weeks came out a few years ago. ACOG, reluctantly followed with a recommendation against elective c-sections and inductions at 37 weeks.

A hospital has a larger financial interest in avoiding unnecessary NICU time than an ob/gyn. Once the baby is born the ob/gyn turns the care of the newborn over to the neonatoligists. As long as the ob/gyn has a live birth the actual outcome of the baby does not affect the ob/gyn. NICU time is expensive and unless the family is wealthy or has a very high end insurance policy, the hospital is at risk for non payment or reduced payment expenses.

This is a good step but don't fool yourself that this will immediately change practice. The ob/gyn codes the reason for the c-section or induction and there is wide latitude for certain codes that can be used instead of elective when scheduling or doctor convenience is the real issue.