Early, elective C-section rate down, too
By Dennis Thompson
WEDNESDAY, June 18, 2014 (HealthDay News) -- After almost two decades of steady increases, the number of U.S. infants born early due to induced labor and C-section has declined in recent years, according to a new report from the Centers for Disease Control and Prevention.
Rates of induced labor declined across the board since 2006 for expectant mothers at 35 to 38 weeks of gestation, with the greatest decline at 38 weeks, researchers with the CDC's National Center for Health Statistics (NCHS) found.
This is good news for the health of these babies, who can face serious health problems when delivered preterm, said Dr. Edward McCabe, chief medical officer for the March of Dimes.
Babies born early are 1.5 to two times more likely to die during their first year of life, compared to babies delivered following a full term of 39 weeks or more, he said.
"There's this feeling that we've done so well with our premature babies, we've been seduced by the advances and think it's safe to induce delivery early," McCabe said. "We've ignored the fact that there are significant risks of illness and death in late preterm and early term babies."
The largest decline in induced labor occurred for early term births at 37 to 38 weeks, which fell 12 percent between 2006 and 2012, the CDC reports. Late preterm births at 34 to 36 weeks of gestation declined by 4 percent.
This decrease comes at a time when medical societies are raising concerns about unnecessary early deliveries.
The rate of induced labor more than doubled between 1990 and 2010, from nearly 10 percent of births to just under 24 percent. While some of these induced births were needed to preserve the life of mother and child, many also occurred to better fit the birth into the busy schedules of the parents or the doctor, McCabe said.
The American Congress of Obstetricians and Gynecologists doesn't recommend induced deliveries prior to 39 weeks of pregnancy without a clear medical reason.
Those new criteria have caused hospitals to change their policies and obstetricians to reconsider their practices, said Dr. Kecia Gaither, vice chair of obstetrics and gynecology, and maternal-fetal medicine at Brookdale University Hospital and Medical Center in New York City.
Since 2010, the overall rate of induced labor has slightly declined, to 23.7 percent in 2011 and 23.3 percent in 2012, according to the report published in the June NCHS Data Brief.
"We found that after increasing nearly every year since 1990, the induction rate peaked in 2010, then declined a little bit in 2011 and a little more in 2012," said lead author Michelle Osterman, a CDC health statistician. "It seems that people are waiting a little longer to let babies be born. That's mostly happening during the early term weeks, and it's a widespread change."
McCabe estimates that if the overall rate had continued to rise, about 176,000 more babies in the United States would have been born prematurely at a cost of more than $9 billion.
"We've given 176,000 more babies a better start at life," he said.
The investigators found that induction rates varied widely based on race, ethnicity and locale. For example, induction rates fell 19 percent for white mothers, but only 7 percent for Hispanics and 3 percent for black mothers.
Declines in labor induction occurred in nearly three out of four states, ranging from 5 percent in Maryland to 48 percent in Utah. Rates increased in Alaska, New York and North Carolina, and remained unchanged in 11 states.
Gaither said this variation is likely due to the quality of prenatal care that expecting mothers receive.
"In places where there's good insurance with good prenatal care, that's where you're seeing the strong decline," she said.
Gaither said she has first-hand experience, because her hospital tends to serve a largely uninsured population with less-than-adequate prenatal care.
"When they come into our institution, they're pretty much crashing and burning. Something ugly is going on that necessitates delivery," she said. "Your back is against the wall to get both of these patients in a safe place, and a lot of the time that means getting these babies delivered."
For more information on induced labor, visit the March of Dimes.
SOURCES: Edward McCabe, M.D., Ph.D., chief medical officer, March of Dimes; Kecia Gaither, M.D., vice chair of obstetrics and gynecology, and director, maternal-fetal medicine, Brookdale University Hospital and Medical Center, New York City; Michelle Osterman, health statistician, U.S. National Center for Health Statistics; June 18, 2014, NCHS Data Brief report, Recent Declines in Induction of Labor by Gestational Age, U.S. Centers for Disease Control and Prevention
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