Reducing Early Inductions in Tennessee

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By Emjaybee


While we’re talking about Tennessee, the article featured in that post was written by Tom Wilemon, who contacted me on March 29 to mention another piece he did that had a more patient-inclusive focus. Jill linked it in the previous comment thread but I thought it deserved its own spot, if only to show that there is a broader take on birth at the Tennessean.

“Hospitals induce labor without medical reason too often,” is a locally-focused version of the news about the results of the LeapFrog Group’s study that came out in January.

What’s interesting about this piece is how it relates to the conversation we’re still having about the previous article:

The historical rise in c-section rates along with inductions:

By 2006, about 1 of every 5 babies came into the world according to somebody else’s schedule. Cesarean sections increased even more, climbing from 5 percent of all births in 1970 to more than 31 percent of births by 2007.

The result was that more babies were born before their 39th week, which carries risks of undeveloped lungs, sudden infant death syndrome and even learning disabilities later in life, according to the March of Dimes.


Money as incentive and disincentive:

One estimate puts the average cost of caring for a premature or low-birth-weight baby at $49,033, compared with $4,551 for an uncomplicated pregnancy.


The uncomfortable tension between doctor advice and patient choice:

“I’ll admit I did beg around 37 or 38 weeks — I started begging — I was losing my patience and my pride at that point,” said Green, of Spring Hill. “But looking back now, I’m glad that we waited.”

Dr. Richard Presley, her obstetrician at Centennial Medical Center, did not induce labor until five days after the 39th week of pregnancy. Green’s extra days of swollen feet gave baby Elizabeth a better chance at life.


Another mother, Tracy Pulley, said her obstetrician started asking her when she wanted to schedule a delivery during the seventh month of her pregnancy.

“I was so stressed out,” said Pulley, whose baby was born in Smyrna. “I just didn’t want to be pressed anymore.”


The value of transparency and good data:

“A large number of hospitals never looked at this and only discovered their high rate when they reported to Leapfrog, which is why we think this has been a very positive measure,” said Leah Binder, Leapfrog CEO.


And (possibly my favorite) the ability to effect significant change through…requiring a simple check box:

Last year, a pilot program in Davidson County that directed doctors to check a form if they were inducing labor for nonmedical reasons had the effect of discouraging such procedures. Early deliveries dropped by half.


By the way, go here for more of Mr. Wilemon’s reporting on healthcare in Tennessee.