Going full term and avoiding the allure of a scheduled C-section: how to get your patients on board

By |2018-03-14T11:58:15-05:00June 1st, 2017|

When it comes to delivering babies, there is one thing that everyone can agree on: expecting parents, nurses, obstetricians, midwives, and pediatricians all strive for a healthy mom and a healthy baby.

However, sometimes it can be really hard to wait for that healthy baby. From parents wanting to know exactly when their baby will be born to obstetricians trying to schedule deliveries on the day they are at the hospital in the hopes of increasing patient satisfaction, there are more and more reasons babies are arriving via scheduled inductions or planned C-sections.Going Full Term

While it is certainly true that some babies need to be delivered before their due date, such as for complications related to preeclampsia, growth restriction, or poorly controlled maternal diabetes, more often than not it is completely possible—and in fact, desirable—to play the waiting game when it comes to labor and birth.

We used to think that once babies were at 37 weeks gestation, they were as developed as they needed to be. Thus, arriving any time after the 37-week mark was the same as waiting until 40 weeks. Thanks to newer research, however, we know this is definitely not the case and that these early term babies have higher rates of problems with breathing, feeding, and maintaining their body temperature. Because of this new information, in 2013 the American Congress of Obstetricians and Gynecologists (ACOG) changed what they defined as being full term. Under the new definition, “full term” doesn’t start until a baby is at least 39 weeks gestation. The goal is to keep as many babies in utero as possible until they reach this important landmark in development, barring any medical complications.

To ensure compliance with this important recommendation, hospitals that provide maternity care are responsible for monitoring their rates of elective deliveries (that is, deliveries that have no medical reason) that happen before 39 weeks. This includes both inductions and scheduled C-sections.

We also know that in the United States, about 1 in 3 babies are born via C-section, which is not ideal for mom and baby for many reasons. Induction of labor—rather than waiting for labor to happen spontaneously—is one major risk factor for needing a C-section. As a result, this is another core measure that hospitals are tracking: the number of first-time moms who end up delivering by C-section.

Since these data are reported (which means patients can search for the local hospital with the lowest C-section and elective induction rates) and may eventually be tied to reimbursement, this puts a lot of pressure on already overworked obstetric providers to stay in line with these recommendations. But how can a doctor or midwife quickly, concisely, and in an evidence-based way convince excited parents to wait to meet their baby and go for a full-term delivery?

One way to get standardized, relatable information to patients outside of short prenatal visits is via weekly email updates. Bundoo has this feature already in place and offers week-by-week pregnancy emails that patients can sign up for at any point in their pregnancy. These emails include information across the entire span of prenatal care, including about the importance of going full-term and aiming for a spontaneous labor and vaginal delivery. All content has been reviewed and written by obstetric providers who reference their material from leading medical organizations. This content also goes in depth on how to stay healthy and minimize the risks for pregnancy complications, which can also put women in the best position for having a term vaginal delivery.

These emails, along with video content developed by The Wellness Network that can play in an office waiting room or individual patient waiting rooms that also target these exact core measures, can assist with JCHAO compliance without any extra time from a busy practitioner.

Higher quality care without any extra physician effort or time needed during a patient visit? Now that’s an intervention most patients (and their doctors!) will gladly get behind.

References

  1. American Congress of Obstetricians/Gynecologists. Committee Opinion #579. Definition of term pregnancy.
  2. Spong CY. Defining “term” pregnancy: recommendations from the Defining “Term” Pregnancy Workgroup. JAMA 2013;309:2445–6.
  3. National Center for Health Statistics. Birth – method of delivery. Centers for Disease Control.