Binder noted that in the last two years, the national average of hospitals' early elective delivery rates without medical necessity dropped from 14% in 2011 to 11.2% in 2012.
Again, as in previous years, hospital rates of early elective deliveries without medical necessity are varied, with six hospitals performing more than 90% of their deliveries as elective inductions or Cesarean sections between 37 and 39 weeks of pregnancy, and some doing none. "Lots of variation is the big story every year we do this survey," Binder said.
Variation is also stark among states. For example, New York and Massachusetts share the lowest rates of 5.9%, but Texas tops the list with rates of 18.3%, followed by Tennessee and Florida at 18.2%.
This year, however, there is evidence that more hospitals are adopting practices that prohibit obstetricians from scheduling premature deliveries in the absence of evidence that without it, the baby or mother would be medically harmed.
For example, John Nash, MD, chairman of the Geisinger Health System's OBGYN department and medical director of women's health, says his system has reduced dangerous deliveries in this fragile period down to zero through rigorous electronic medical record systems to track their physicians practices "and identify when protocols are not being followed.
"There has got to be at some point in the organization, what is termed a 'hard stop.' In other words, if a physician or patient is requesting a delivery before 39 weeks, which is associated with a two-fold increase in morbidity risk to the neonate... we have a tracking system."