CHARLESTON, W.Va. -- Expectant mothers had various reasons for wanting to deliver their babies early.
They may have wanted their children born on a grandmother's birthday, or they may have become intolerant of the side effects of late pregnancy. And most thought it was safe to have a baby from 36 to 38 weeks gestation.
"It just had become so accepted," Nancy Tolliver said of the practice of inducing labor before 39 weeks.
And it wasn't always done at the convenience of the mother, said Tolliver, director of the West Virginia Perinatal Partnership.
She outlined this scenario. A pregnant woman has pains and thinks she is going into labor. She is taken to the hospital, a two-hour drive away. But she isn't; labor is still several hours off. Although it's best not to admit her, the doctor is afraid to send her home. She is admitted, but there's a time limit on how long she can stay. So her doctor decides to induce labor.
In 2008, nearly 36 percent of births in West Virginia were induced. Thirteen percent of births were induced before full term, and more than half of those were done for non-medical reasons.
That last statistic has been slashed by 60 percent in the past year -- since teams assembled in 14 West Virginia hospitals confronted the problem.
This year, 27 of 29 West Virginia hospitals are tackling a related issue: West Virginia has the fourth highest rate of cesarean births.
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It was a classic case of one thing leading to another.
It was 2006. The year before West Virginia had gotten its worst ranking on the well being of its children -- 47th out of 50 in the Kids Count national survey.
"West Virginia was facing a very high infant morality rate," said Tolliver. "We also had high rates of other things considered bad."
The Perinatal Partnership was funded by The Benedum Foundation to improve mother and baby wellbeing.
One of the first things the partnership undertook was a survey of 200 medical providers of maternity services. One problem uncovered was that pediatricians in rural areas were having trouble getting sick babies into any of the three hospitals in West Virginia that have neonatal intensive care units. Their beds were full, and babies were being sent out of state for care.
While looking into why infants were in intensive care units, Tolliver said they noticed "a very large increase in induction of labor prior to full term."
At the same time, Tolliver said national studies were showing that labor induced deliveries had "a lot of poor outcomes, especially for first time mothers. In West Virginia, there was more than a 30 percent chance they would end up having a cesarean. That's why we embarked on the project."
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The project is titled West Virginia Quality Collaborative for Eliminating Non-Medically Indicated Elective Preterm Deliveries Prior to 39 Weeks Gestation.
Organizations that developed the study were the West Virginia Health Care Authority, the West Virginia Health Improvement Institute, The West Virginia Perinatal Partnership and the West Virginia Chapter of the March of Dimes.
The 14 hospitals, which account for 70 percent of all births in the state, were Raleigh General, St. Joseph's in Buckhannon, CAMC, Thomas Memorial, Cabell Huntington, St. Mary's, Greenbrier Valley Medical Center, Monongalia Health System, West Virginia University Hospital, Camden-Clark, Princeton Hospital, Ohio, Valley Medical Center, Reynolds Memorial, and Weirton Medical Center.