It’s more complicated than that. Yes, part of it is public policy and public choices. But it’s also the changing nature of medicine, and the changing nature of health, the changing nature of birth. I work as a doctor in a rural town. People wonder why our hospital doesn’t do births anymore, and instead ships all births off to the next nearest hospital 2.5 hours away. They figure that since they were born at the local hospital, that it should still be able to deliver babies. But this was back when the average first birth was to a woman age 19 or 20. Moms were much younger and healthier. And if a baby didn’t survive? That was divine will, and you’ll have 5 more. Our little hospital and ER really functions at the sophistication level of an urgent care. We get tons of grant money from the government to help us stay open, but it still can’t pay for what a real hospital has–all the fancy equipment but especially all the highly trained professionals to run it all. Who wants to live in the middle of nowhere where their spouses can’t even find a job? Our area has tons of natural beauty and recreational opportunities, but it’s still not enough to attract the permanent staff you need.
Okay I understand that. That’s true of the area we bought our retirement home in, sadly. So I get that. But this decision doesn’t seem to be grounded in those circumstances. And I do think that to some extent, policy and profit parameters do have some effect, in most places.
Not amused? A lot worse than that. She was at significantly increased risk of late fetal demise, that most horrible thing when the perfect, fully-formed, full-term baby dies in utero at the end of the pregnancy. Research has shown that it’s actually safer to not go past 39 weeks. I had 3 inductions. One at 37 for high blood pressure, one at 39 only because my mean OB wouldn’t let me schedule it for 38, and the last at 38 weeks. I wanted that baby OUT where I could take care of it. I was terrified of a late fetal demise.
An emergency c-section is different than a planned one. If Florida (and other states) are now allowing emergency c-sections to be covered (doctors insured, equipment available) that’s different than planning c-sections in rural areas. IMO, it would still be better to deliver in a hospital when possible even if that means traveling 2 hours, and even if it means relocating to a city at 37 weeks if a c-section is going to be necessary.
But how much does lack of money prevent people in rural areas from doing this?
Exactly! This is what the pregnant women in my rural town now do. They go to the hospital for induction. That way they don’t have to wait for labor and then drive 2.5 hours (in the middle of the night! in a snow storm!) AND their outcomes are better. Routine induction by 39 weeks prevents stillbirths while simultaneously reducing C-section rate.
Just chiming in to say I bypassed our small, rural hospital with no NICU, nor even an anesthesiologist always available, for the bigger hospital an hour away.
My 3rd son was born in the car on the way. (Makes a great story now!)
I also skipped the closest hospital to go to the hospital with the high level NICU with our D. The hospital was 90 minutes away. Thankfully we made it in time.
I delivered both of mine at a hospital in Northern Virginia which was not the closest to me. But it had a high level NICU (didn’t need, thankfully) and at that time had the US’s second highest number of babies delivered there each year.
No one told me that. I was allowed to go 10 days past my due date before I was induced – and we knew precisely when conception was.
I can assure you it is cheaper to go to a hospital and deliver safely than to have to spend weeks in an NICU after a birth with complications.
My daughter spent months in the NICU and I saw a lot of kids come in who were born (or almost born but airlifted in) in other hospitals around the state or even out of state. It is a risk of living in rural areas, on ranches, even in smaller towns and cities (many came from Colorado Springs and Pueblo because they needed a Level 3 NICU).
Some stay at a Ronald McDonald house or, attached to my daughter’s hospital, a St. Christopher’s house which don’t charge for the stay. This was for pre or post natal stays, but everyone would have preferred pre birth stays.
My niece was also born in the parking lot of the hospital, as it was just about 10 minutes too far. They lived in the mountains, woke up to snow (June 10th!), had to get their other child and the dog ready to go, and started driving, arriving at rush hour. Luckily, she was very healthy and they estimated her at 41 weeks, not the 38 my SIL ‘thought.’ There were closer hospitals, but not much closer.
I understand that rural centers do the best they can. They aren’t always in poor areas (there is a commercial running here that Craig Colorado is a maternity desert - it is 30 minutes from Steamboat, one of the most expensive places to live). I’m glad they (and places in Florida) can handle emergencies, but I don’t think they should be doing planned C-sections
I’m sure there is more money involved than not in any of these decisions. There wouldn’t be a clinic in even the remotest of places if it can’t be supported economically or attract staff to man it. This may be an incentive to even keep a clinic open where none may otherwise exist. There aren’t any perfect solutions.
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We all have stories of perfect births and the way "less " than perfect. Presently getting induced is the new norm. Everyone signing up? 20% failure rate.
Is that better for baby or mom? Or does it make the health care system cheaper since it runs on a schedule? (my AI question says its very convenient…) But who knows.
A NICU nurse I know is still furious that her newborn was sent to NICU (at her own hospital) for no reason other than to run up the insurance bill. I don’t doubt her.
It used to be accepted medical practice to let women go to 41 weeks, and of course those who eschew traditional medical care would go even later, 42 weeks or more. But it has now been recognized that the risk of the baby growing too big to deliver, or just dying suddenly in utero, is too high, and that the ideal time to deliver is 38-39 weeks. But that may require induction.
Definitely true. I saw unwarranted NICU admissions and babies kept in the NICU longer than they should have been. They’d get admitted to the NICU to spend a few hours under a head box for O2 that they didn’t need, for respiratory distress that they didn’t have, just to generate charges. I saw babies kept in for unnecessary phototherapy for totally normal, not dangerous levels of jaundice, to generate charges. I saw unwarranted admissions to the community hospital’s Pedi ward, and kids kept in way longer than they needed to have been. I would walk in on call on a Sunday morning, find all these kids that my dear old men partners had admitted and just left sitting in the hospital, who absolutely did not need to be there, and just work furiously clearing the decks, sending them all home. Didn’t endear me to them, that’s for sure. I remember one of the bolder nurses saying to one of those docs, “Dr. Oldman, are you buying a boat?”
But I completely, absolutely agree with elective inductions at 39 weeks, and mandatory inductions at 40 weeks, because the outcome for the babies is better.
Very interesting to me! In my area when I had mine, the practice was not to induce before 42 weeks. Fortunately, mine came at 39 and 39 weeks, 6 days. But I know now, they don’t let them go past 40 around here. I wondered why that was the case.
And two people in my office (one grandchild, one child) had disastrous full term births that resulted in the baby not making it and the mother almost passing away. Horrible. Beyond horrible
This happened to me. My OB wouldn’t induce until 41 weeks and our son died the day after he was born. In the hospital with the highest level NICU. There are no guarantees regardless of where you deliver.
My next pregnancy the OB wouldn’t let me go past 39 weeks. D arrived on her own without induction at 37 1/2 weeks.
I am so very, very sorry for your loss.
Yes, but some people may not have the money (and/or medical insurance) for either. For some people, any up front cost (including travel to a distant hospital, hotel room near such hospital) can be a barrier to taking that path, even if the total overall cost of that path ends up being less.
The one I work at is open only due to large government subsidies. And like many of the doctors who work there, I don’t live there. They pay for my travel and lodging in addition to my salary.
Recommendations have changed due to 1) better technology and 2) quality studies.
Technology: In decades past, the technology to accurately date pregnancies was not available. Ultrasounds were still crude. So pregnancy dates were estimated based off of the first day of the last menstrual period. However some women do not have normal 28 day cycles where they ovulate on day 14. For example some women may not ovulate until day 20 or 25 or 30 etc. So their pregnancies may have been 40 weeks based on her last period, but really only 37 or 38 weeks. So if you induced at “40 weeks” you might actually be inducing a slight preemie. However, ultrasounds are now very accurate, and it is routine for a woman to be given a dating ultrasound early in pregnancy. So now when a woman is “40 weeks” you can be much more sure she is 40 weeks.
Quality studies: in recent years there have been some really large and well designed studies that show that routine induction at 39 weeks reduces neonatal deaths without increasing C-section rate (actually reducing C-section rate slightly in comparison to letting the pregnancies go to 41 weeks)