Controlling Elective Inductions at Intermountain Brings Benefits to Mothers and Newborns

Intermountain Healthcare

A few years ago, Intermountain noticed a striking trend that was part of a larger national phenomenon. Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age. Intermountain’s medical research team was concerned that early inductions might have negative health consequences for babies and moms. Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary. Today, there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units.


Elective Inductions

Utah has the highest birthrate in the nation, so it may not be surprising that close to 33,000 babies are delivered every year at Intermountain Healthcare, a Salt Lake City-based system of nonprofit hospitals and clinics. In fact, labor and delivery is the most common admission for Intermountain’s 18 hospitals that offer the service. But beyond delivering lots of babies, Intermountain Healthcare also has a national reputation for quality improvement efforts, which are supported by a sophisticated electronic medical record system.

A few years ago, Intermountain noticed a striking trend that was part of a larger national phenomenon. Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age. Intermountain’s medical research team was concerned that early inductions might have negative health consequences for babies and moms. When they analyzed the data from births at Intermountain’s hospitals, they found that women who deliver before babies reach 39 weeks gestational age tend to have longer and more complicated deliveries. Researchers also found a statistically significant increase in the number of newborns with medical complications.

Specifically, the data showed that of babies delivered at 37 weeks gestational age, 8.85 percent were admitted to the neonatal intensive care unit. The number dropped to 4.51 percent of babies delivered at 38 weeks and then bottomed out to 3.34 percent at 39 weeks. The percentage of NICU admissions climbs slowly for babies born at 40 weeks gestational age and beyond. So according to Intermountain’s statistics, hitting the magic 39-week mark seemed to significantly cut the chances of a baby being sent to the NICU.

But that wasn’t all the research found. Babies also were more likely to struggle with respiratory distress syndrome if physicians electively induced labor before 39 weeks. The data showed that if delivery occurs at 37 weeks, 1.92 percent of babies were affected. At 38 weeks the percentage drops to .68 percent and bottoms out at .42 percent at 39 weeks, before slightly climbing again at 40 weeks. The need for newborns to be on a ventilator was also significantly reduced if delivery occurred at 39 weeks gestational age.

Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary. Today, there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units.

In 1999, approximately 28 percent of all inductions at Intermountain’s hospitals occurred before 39 weeks. Today, that percentage is near two percent. And with the significant drop in early elective inductions, Intermountain has also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer cesarean sections (about 21 percent compared to the national average of 31 percent) and other medical complications associated with deliveries. The guidelines benefit new babies and their moms. And as icing on the cake, the protocol has also saved patients millions each year.

Keywords: early elective inductions, evidence-based medicine, labor and delivery, labor induction, Intermountain Healthcare, neonatal, NICU, quality improvement, Salt Lake City, Utah, safety, treatment, value

FOR MORE INFORMATION:

Dave Green
Communications Manager
Intermountain Healthcare
36 South State Street
Salt Lake City, UT 84111
tel. 801.442.2844
dave.green@ihc.com
www.ihc.com