Minn. launches effort to prevent early births

Renee Palmquist
One-week-old Regan Palmquist is in the intensive care unit at North Memorial Hospital in Robbinsdale. Her mother Renee Palmquist of Maple Grove went into early labor with Regan and her brother Mason when the twins reached 35 weeks gestation. A full-term pregnancy is 40 weeks. Regan is being treated for jaundice, temperature control and feeding issues. Even babies who are born early just a few weeks from their due dates can have multiple health problems.
Photo courtesy of North Memorial Hospital/Trudy Marshall

A new Minnesota birth campaign seeks to dispel the notion that it's safe to schedule an elective delivery before 39 weeks of pregnancy.

Approximately one in 10 babies born in Minnesota is premature. Some of those preterm births are unavoidable, but health officials believe many mothers are giving birth through Caesarean sections or induced labor earlier than they should, causing unnecessary health problems for some newborns.

The "Healthy Babies are Worth the Wait" campaign targets parents who assume their babies will be fine if born a few weeks early. The campaign is organized by the March of Dimes, two state agencies and Minnesota hospitals.

Elective deliveries are often scheduled too early out of convenience, said Dr. Jon Nielsen, medical director of women's and children's services at North Memorial Medical Center in Robbinsdale and Maple Grove Hospital.

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Sometimes they take place early so that doctors can mothers can ensure they will be in town at the same time, he said.

"What happens is traditionally is the mother is sick of being pregnant," Nielsen said. "You do those kinds of deals and come up with a 38-week day that seems to make sense."

Besides convenience, there's also some confusion over the definition of a full-term pregnancy. Many consumer books and websites tell expectant mothers that babies are full-term when they reach 37 weeks gestation.

"More than half of moms think it's safe to deliver between 34 and 36 weeks. But this just isn't so."

State Commissioner of Health Ed Ehlinger said that information misleads mothers, because it ignores the fact that a lot of important development happens in the final weeks of pregnancy.

"We have to change that definition," Ehlinger said. "Really a full-term baby is 40 weeks. Yet studies have shown that more than half of moms think it's safe to deliver between 34 and 36 weeks. But this just isn't so."

A baby born even a couple weeks early may have trouble staying warm or feeding properly, requiring a longer hospitalization. Ehlinger said the baby could also experience hearing and vision problems.

It is unclear how many elective deliveries are scheduled before 39 weeks gestation. National studies have reported rates of 28 to nearly 36 percent in the United States.

Minnesota hospitals are not required to publicly disclose such information, but some have voluntarily disclosed that their rates exceeded 10 to 20 percent before they adopted policies to reduce the number of scheduled early deliveries.

A recent change in state Medicaid policy may be one reason some hospital preterm birth rates have declined. Earlier this year, the state Department of Human Services told hospitals that it would begin scrutinizing the timing of their scheduled deliveries if they receive Medicaid payments, Human Services Commissioner Lucinda Jesson said.

Medicaid pays for nearly 40 percent of the births in Minnesota.

"We used our power as a payer to say to hospitals, 'Look, if you do not have a policy in place restricting elective deliveries before 39 weeks, then we're just not going to automatically pay those bills. We're going to ask a lot more questions,' " Jesson said.

The Minnesota Hospital Association reports that 88 of the 95 Minnesota hospitals that deliver babies have now adopted tougher policies on scheduled births.

North Memorial in Robbinsdale is one of them. Physicians must now defend their reasons for requesting a scheduled delivery prior to 39 weeks if there isn't a valid medical reason, Nielsen said.

"We've found that the doctors don't like to have those discussions," he said. "You do it once and then they don't want to do that again, because it's kind of outside the limits of what we know what we should be doing. So just by education and standardization of both the patients and the doctors, we've moved those numbers to -- in our hospital here it's less than 1 percent."

Minnesota health leaders have set a goal of reducing the state's premature births by 8 percent by 2014. If they achieve that goal, they say 550 babies will be spared the risks associated with being born too soon.